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Original article

Vol. 144 No. 4950 (2014)

Treatment outcomes of multidrug-resistant tuberculosis in Switzerland

  • Peter Helbling
  • Ekkehardt Altpeter
  • Jean-Marie Egger
  • Jean-Pierre Zellweger
Cite this as:
Swiss Med Wkly. 2014;144:w14053


OBJECTIVE: To assess outcomes 24 months after treatment start for multidrug-resistant tuberculosis (MDR-TB).

METHODS: Cohort study of all culture-positive MDR-TB cases notified in Switzerland from 01/2003 to 07/2010.

RESULTS: Fifty-one cases were observed, with a median age of 26 years (range 2–56). Twenty-seven were male, five of Swiss origin, 46 of foreign origin (Asia 18, Africa 13, former Soviet Union 8), including 21 asylum seekers and refugees. Twelve had received a previous treatment for TB and 24 had not (15 unknown). Forty-four cases were pulmonary of which 25 were known to be sputum smear positive. All but two strains showed additional resistances: 29 to ethambutol, 27 to pyrazinamide, 6 to a fluoroquinolone, 5 to amikacin. None was resistant to both of the latter two classes. Molecular analyses showed three pairs of identical strains.

Fluoroquinolones were used in 48 patients and second-line injectable drugs in 37. The median duration of MDR treatment was 18 months (range 1–26).

The outcome after 24 months was successful in 39 (76%) and unsatisfactory in 12 (24%) patients: two deaths from TB; two treatments terminated owing to side effects of drugs and one owing to pregnancy; four defaults from treatment at months 0, 4, 8, and 21; two transfers abroad with unknown outcome; one outcome unknown. There was no significant association of unfavourable outcomes with age, sex, origin, previous treatment, treatment delay, resistance pattern, and classes of drugs used.

CONCLUSIONS: MDR-TB in Switzerland occurs mostly in persons of foreign origin. Results of decentralised treatments were satisfactory.


  1. World Health Organization. Global Tuberculosis Report 2013. WHO/HTM/TB/2013.11.
  2. Zignol M, van Gemert W, Falzon D, Sismanidis C, Glaziou P, Floyd K, et al. Surveillance of anti-tuberculosis drug resistance in the world: an updated analysis, 2007–2010. Bull World Health Organ. 2012;90(2):111–119D.
  3. Zhao Y, Xu S, Wang L, Chin DP, Wang S, Jiang G, et al. National survey of drug-resistant tuberculosis in China. N Engl J Med. 2012;366(23):2161–70.
  4. Skrahina A, Hurevich H, Zalutskaya A, Sahalchyk E, Astrauko A, Hoffner S, et al. Multidrug-resistant tuberculosis in Belarus: the size of the problem and associated risk factors. Bull World Health Organ. 2013;91(1):36–45.
  5. Office fédéral de la santé publique. La tuberculose en Suisse 2005–2011. Bulletin OFSP 2013;21:343–53.
  6. Minion J, Gallant V, Wolfe J, Jamieson F, Long R. Multidrug and extensively drug-resistant tuberculosis in Canada 1997–2008: demographic and disease characteristics. PLoS One. 2013;8(1):e53466.
  7. Caminero JA, Sotgiu G, Zumla A, Migliori GB. Best drug treatment for multidrug-resistant and extensively drug-resistant tuberculosis. Lancet Infect Dis. 2010;10(9):621–9.
  8. Helbling P, Medinger C, Altpeter E, Raeber PA, Beeli D, Zellweger JP. Outcome of treatment of pulmonary tuberculosis in Switzerland in 1996. Swiss Med Wkly. 2002;132(35-36):517–22.
  9. Ahuja SD, Ashkin D, Avendano M, Banerjee R, Bauer M, Bayona JN, et al. Multidrug resistant pulmonary tuberculosis treatment regimens and patient outcomes: an individual patient data meta-analysis of 9,153 patients. PLoS Med. 2012;9(8):e1001300.
  10. Orenstein EW, Basu S, Shah NS, Andrews JR, Friedland GH, Moll AP, et al. Treatment outcomes among patients with multidrug-resistant tuberculosis: systematic review and meta-analysis. Lancet Infect Dis. 2009;9(3):153–61.
  11. Johnston JC, Shahidi NC, Sadatsafavi M, FitzGerald JM. Treatment outcomes of multidrug-resistant tuberculosis: a systematic review and meta-analysis. PLoS One. 2009;4(9):e6914.
  12. Laserson KF, Thorpe LE, Leimane V, Weyer K, Mitnick CD, Riekstina V, et al. Speaking the same language: treatment outcome definitions for multidrug-resistant tuberculosis. Int J Tuberc Lung Dis. 2005;9(6):640–5.
  13. Caminero JA, ed. Guidelines for clinical and operational management of drug-resistant tuberculosis. Paris, France: International Union Against Tuberculosis and Lung Disease; 2013.
  14. Bottger EC. The ins and outs of Mycobacterium tuberculosis drug susceptibility testing. Clin Microbiol Infect. 2011;17(8):1128–34.
  15. World Health Organization. Definitions and reporting framework for tuberculosis – 2013 revision. WHO/HTM/TB/2013.2.
  16. Gimmi R, Pfyffer GE, Brändli O. Tuberculose multirésistante – guérissable en Suisse. Forum Med Suisse. 2003;4:80–90.
  17. European Centre for Disease Prevention and Control. Tuberculosis surveillance and monitoring in Europe 2013. European Centre for Disease Prevention and Control; Stockholm, 2013.
  18. Leimane V, Dravniece G, Riekstina V, Sture I, Kammerer S, Chen MP, et al. Treatment outcome of multidrug/extensively drug-resistant tuberculosis in Latvia, 2000–2004. Eur Respir J. 2010;36(3):584–93.
  19. Van Deun A, Maug AK, Salim MA, Das PK, Sarker MR, Daru P, et al. Short, highly effective, and inexpensive standardized treatment of multidrug-resistant tuberculosis. Am J Respir Crit Care Med. 2010;182(5):684–92.
  20. World Health Organization. Guidelines for the programmatic management of drug-resistant tuberculosis – 2011 update. WHO/HTM/TB/2011.6.
  21. Lee M, Lee J, Carroll MW, Choi H, Min S, Song T, et al. Linezolid for treatment of chronic extensively drug-resistant tuberculosis. N Engl J Med. 2012;367(16):1508–18.
  22. Yew WW, Lange C, Leung CC. Treatment of tuberculosis: update 2010. Eur Respir J. 2011;37(2):441–62.
  23. Fox W, Ellard GA, Mitchison DA. Studies on the treatment of tuberculosis undertaken by the British Medical Research Council tuberculosis units, 1946-1986, with relevant subsequent publications. Int J Tuberc Lung Dis. 1999;3(10 Suppl 2):S231–S279.
  24. Mitchison D, Davies G. The chemotherapy of tuberculosis: past, present and future. Int J Tuberc Lung Dis. 2012;16(6):724–32.
  25. Leung EC, Yew WW, Leung CC, Leung WM, Tam CM. Shorter treatment duration for selected patients with multidrug-resistant tuberculosis. Eur Respir J. 2011;38(1):227–30.
  26. Cox HS, Niemann S, Ismailov G, Doshetov D, Orozco JD, Blok L, et al. Risk of acquired drug resistance during short-course directly observed treatment of tuberculosis in an area with high levels of drug resistance. Clin Infect Dis. 2007;44(11):1421–7.
  27. van der Werf MJ, Langendam MW, Huitric E, Manissero D. Multidrug resistance after inappropriate tuberculosis treatment: a meta-analysis. Eur Respir J. 2012;39(6):1511–9.
  28. Royce S, Falzon D, Van WC, Dara M, Hyder K, Hopewell P, et al. Multidrug resistance in new tuberculosis patients: burden and implications. Int J Tuberc Lung Dis. 2013;17(4):511–3.
  29. Gler MT, Skripconoka V, Sanchez-Garavito E, Xiao H, Cabrera-Rivero JL, Vargas-Vasquez DE, et al. Delamanid for multidrug-resistant pulmonary tuberculosis. N Engl J Med. 2012;366(23):2151–60.
  30. Diacon AH, Donald PR, Pym A, Grobusch M, Patientia RF, Mahanyele R, et al. Randomized pilot trial of eight weeks of bedaquiline (TMC207) treatment for multidrug-resistant tuberculosis: long-term outcome, tolerability, and effect on emergence of drug resistance. Antimicrob Agents Chemother. 2012;56(6):3271–6.
  31. Diacon AH, Dawson R, Hanekom M, Narunsky K, Venter A, Hittel N, et al. Early bactericidal activity of delamanid (OPC-67683) in smear-positive pulmonary tuberculosis patients. Int J Tuberc Lung Dis. 2011;15(7):949–54.

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