**10. XDR-TB treatment**

A previous study in Peru by Mitnick CD *et al*. demonstrated that 48 (7.4%) of 651 tested-isolate patients had XDR-TB [71]. The results showed various individualized regimens prescribed for 47 patients with XDR-TB as the following : 1) 14.9% of the patients included ethambutol, 2) 34.0% included pyrazinamide, 3) 38.3% included streptomycin, 4) 19.1% included amikacin, 5) 53.2% included capreomycin, 6) 17.0% included kanamycin, 7) 21.3% included ciprofloxacin, 8) 12.8% included ofloxacin, 9) 42.6% included levofloxacin, 10) 2.1% included spafloxacin, 11) 72.3% included moxifloxacin, 12) 100% included cycloserine, 13) 66.0% included ethionamide, 14) 95.7% included para-aminosalicylic acid, 15) 100% included amoxicillin-clavulanate, 16) 44.7% included clarithromycin, 17) 97.9% included clofazimine, 18) 17.0% included rifabutin, 19) number of drugs in regimen (number without documented resistance or prior exposure for more than 1 month) : 19.1) 5.3 +/- 1.3 agents among all available agents, 19.2) 3.2 +/- 1.2 agents among 12 agents or classes for which routine DST was performed, 20) median duration of treatment with injectable agents : 15.4 months, and 21) median duration of treatment ranged 8.0- 24.9 months, median duration from treatment initiation to surgery : 11.6 months, and median duration of treatment for patients undergoing surgery : 31.2 months [70]. The median duration of follow-up was 19.4 months [71]. Treatment outcomes revealed that 60.4% of patients were cured or completed treatment [71]. This study is currently the up-to-date information of XDR-TB treatment. Positive AFB-smear, and urban residence could be predic‐ tors of poor treatment outcomes in XDR-TB [70]. For patients with mono/poly-resistant drug (s) TB, the recommended treatment regimens are shown in the Table 4 (13).

pleteness of treatment, 29.1% cured, 20.5% default, 2.2% treatment failure, and 21.5% died [9]. Treatment failure and treatment default rates were higher among new case compared to the patients with previous TB treatment whereas higher death rates were found among the patients with previous TB treatment. This could be due to inadequately strict- and intensivehealth education provision to the new cases and more severe disease at the time of diagnosis among the patients with previous TB treatment. Only 27.5% of cases with completed treatment

A recent study in South Korea revealed that the treatment regimen was individualized based on the history of anti-TB drugs taken by the patient and the most DST result [69]. Three to seven anti-TB drugs were self-administered except injectable drugs during hospitalization [69]. Injectable drugs were prescribed for 6-7 months [69]. The total treatment duration was at least 18 months after sputum culture conversion [69]. If the medical treatment was expected to fail or had failed in patients with localized lung cavities, or bilateral lesions and anticipated adequate postoperative lung function, surgical resection was considered [69]. The treatment outcomes showed that 37.1% of patients had treatment success, and 4.5% of them died of all causes during the 3-4 years after treatment initiation [69]. The independent predictors of allcause mortality were age, history of MDR-TB treatment, XDR-TB, and prothionamide resist‐ ance [69]. Currently, there is no DOTS programme implementation in South Korea [69] while Thailand has been implemented several years ago, but the treatment outcomes were better than that of Thailand [9, 69]. These different results of both projects should be intensively investigated and explained. Kliiman K *et al*. recently demonstrated that predictors of poor treatment outcomes in MDR-TB were previous TB treatment, ofloxacin resistance, positive-

The criteria for capacity of establishment of the specialized MDR-TB centre that recommended by the Thailand' s 2012 NTP guidelines [24] are as the following : 1.authorized persons' recognition of the MDR-TB threats 2.good laboratory networks and good patient-referral

A previous study in Peru by Mitnick CD *et al*. demonstrated that 48 (7.4%) of 651 tested-isolate patients had XDR-TB [71]. The results showed various individualized regimens prescribed for 47 patients with XDR-TB as the following : 1) 14.9% of the patients included ethambutol, 2) 34.0% included pyrazinamide, 3) 38.3% included streptomycin, 4) 19.1% included amikacin, 5) 53.2% included capreomycin, 6) 17.0% included kanamycin, 7) 21.3% included ciprofloxacin, 8) 12.8% included ofloxacin, 9) 42.6% included levofloxacin, 10) 2.1% included spafloxacin, 11) 72.3% included moxifloxacin, 12) 100% included cycloserine, 13) 66.0% included ethionamide, 14) 95.7% included para-aminosalicylic acid, 15) 100% included amoxicillin-clavulanate, 16) 44.7% included clarithromycin, 17) 97.9% included clofazimine, 18) 17.0% included rifabutin, 19) number of drugs in regimen (number without documented resistance or prior exposure for more than 1 month) : 19.1) 5.3 +/- 1.3 agents among all available agents, 19.2) 3.2 +/- 1.2

system 3.good DOT system, and 4.consistently continuous care for MDR-TB patients.

were followed up more than 2 months [9].

254 Tuberculosis - Current Issues in Diagnosis and Management

AFB smear, and HIV-infection/AIDS [70].

**10. XDR-TB treatment**


**Table 4.** Treatment of patients with mono-drug resistant and poly-drug resistant tuberculosis [13]
