Aggressive Regimens for Multidrug-Resistant Tuberculosis Reduce Recurrence

Background. Recurrent tuberculosis disease occurs within 2 years in as few as 1 % and as many as 29 % of individuals successfully treated for multidrug-resistant (MDR) tuberculosis. A better understanding of treatment-related factors associated with an elevated risk of recurrent tuberculosis after cure is urgently needed to optimize MDR tuberculosis therapy. Methods. We conducted a retrospective cohort study among adults successfully treated for MDR tuberculosis in Peru. We used multivariable Cox proportional hazards regression analysis to examine whether receipt of an aggressive MDR tuberculosis regimen for ≥18 months following sputum conversion from positive to negative was associated with a reduced rate of recurrent tuberculosis. Results. Among 402 patients, the median duration of follow-up was 40.5 months (interquartile range, 21.2– 53.4). Receipt of an aggressive MDR tuberculosis regimen for ≥18 months following sputum conversion was asso-ciated with a lower risk of recurrent tuberculosis (hazard ratio, 0.40 [95 % confidence interval, 0.17–0.96]; P =.04). A baseline diagnosis of diabetes mellitus also predicted recurrent tuberculosis (hazard ratio, 10.47 [95 % confi-dence interval, 2.17–50.60]; P =.004). Conclusions. Individuals who received an aggressive MDR tuberculosis regimen for ≥18 months following sputum conversion experienced a lower rate of recurrence after cure. Efforts to ensure that an aggressive regime