AIDSWEEKLY Plus, Monday, 24 March 1997
Salynn Boyles, Senior Editor
An inadequate supply of second-line antituberculosis drugs contributed to the spread of multidrug-resistant tuberculosis during a nosocomial outbreak in Buenos Aires, Argentina.
The outbreak included more than 250 cases of multidrug- resistant tuberculosis occurring in HIV positive patients treated at a 500-bed infectious disease hospital.
The nosocomial outbreak was reported by researchers from the U.S. Centers for Disease Control and Prevention (CDC) at the International Union Against Tuberculosis and Lung Disease North American Region Second Mid Year Conference, held February 27 - March 2, 1997 in Chicago, Illinois.
Transmission of multidrug-resistant tuberculosis has occurred at the Buenos Aires hospital since 1992 and affected patients are resistant to isoniazid, rifampin, ethambutol, streptomycin, and kanamycin and/or pyrazinamide.
CDC researchers reviewed the charts of 89 outbreak cases from January through November 1996. Of these, 25 (28 percent) died prior to the recognition of multidrug resistance.
Of the remaining 64, at least 18 (28 percent) had all medications stopped intermittently due to lack of availability of second-line medications (prothionamide, terizidone, clofazimine, ofloxacin, PAS).
"Procurement of second line antituberculous medications for treatment of multidrug-resistant tuberculosis has been difficult," the CDC's Renee Ridzon noted. "Only ofloxacin is produced domestically; all others must be imported and are subject to duty taxes. For imported medications, there are delivery delays and supplies of certain medications are scarce."
In addition, the National Tuberculosis Program has insufficient funding to pay for the medications.
"Uninterrupted treatment with second line antituberculous medications is essential to effectively treat patients, prevent development of further resistance, and prevent continued nosocomial transmission of multidrug-resistant tuberculosis," Ridzon noted. "Strategies must be designed to secure a consistent supply of second-line medications in order to control this outbreak."
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