Bulletin of the World Health Organization (Jan 2012)

Eliminating the category II retreatment regimen from National Tuberculosis Programme guidelines: the Georgian experience

  • Jennifer Furin,
  • Medea Gegia,
  • Carole Mitnick,
  • Michael Rich,
  • Sonya Shin,
  • Mercedes Becerra,
  • Peter Drobac,
  • Paul Farmer,
  • Rocio Hurtado,
  • J Keith Joseph,
  • Salmaan Keshavjee,
  • Iagor Kalandadze

Journal volume & issue
Vol. 90, no. 1
pp. 63 – 66

Abstract

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PROBLEM: The category II retreatment regimen for management of tuberculosis in previously treated patients was first introduced in the early 1990s. It consists of 8 months of total therapy with the addition of streptomycin to standard first-line medications. A review of 6500 patients on category II therapy in Georgia showed poor outcomes and high rates of streptomycin resistance. APPROACH: The National Tuberculosis Program used an evidence-based analysis of national data to convince policy-makers that category II therapy should be eliminated from national guidelines in Georgia. LOCAL SETTING: The World Health Organization tuberculosis case-notification rate in Georgia is 102 per 100 000 population. All patients receive culture and drug susceptibility testing as a standard part of tuberculosis diagnosis. In 2009, routine surveillance found multidrug-resistant tuberculosis in 10.6% of newly diagnosed patients and 32.5% of previously treated cases. RELEVANT CHANGES: Category II retreatment regimen is no longer used in Georgia. Treatment is guided by results of drug susceptibility testing - using rapid, molecular tests where possible - for all previously treated tuberculosis patients. LESSONS LEARNT: There was little resistance to policy change because the review was initiated and led by the National Tuberculosis Program. This experience can serve as a successful model for other countries to make informed decisions about the use of category II therapy.