Arnold A, et al. – This study was performed to examine the relative adverse effects of capreomycin and amikacin in multidrug–resistant tuberculosis. Observations revealed no difference in the number of patients experiencing a rise in the creatinine level of >1.5 times the baseline level. A frequent hearing loss in this cohort was observed, though its incidence was significantly lower in those starting capreomycin, which should be given greater consideration as a first–line agent.

Methods

•  The case notes of 100 consecutive patients treated at four MDR-TB treatment centers in the United Kingdom were reviewed.

Results

• Treatment with an injectable agent was provided for median total duration of 178 days (interquartile range [IQR], 109 to 192 days; n = 73) to those with MDR-TB, 179 days (IQR, 104 to 192 days; n = 12) to those with MDR-TB plus fluoroquinolone resistance, and 558 days (IQR, 324 to 735 days; n = 8) to those with extensively drug-resistant tuberculosis (XDR-TB).
• It was observed that injectable use was longer for those started with capreomycin (183 days; IQR, 123 to 197 days) than those started with amikacin (119 days; IQR, 83 to 177 days) (P = 0.002).
• Excluding patients with XDR-TB, 51 of 85 (60%) patients received an injectable for over 6 months and 12 of 85 (14%) received an injectable for over 8 months as treatment regimen.
• Discontinuation of injectable treatment was observed in 40% of patients due to hearing loss.
• Ototoxicity was encountered in 55% of patients, this was 5 times (hazard ratio [HR], 5.2; 95% confidence interval [CI], 1.2 to 22.6; P = 0.03) more likely to occur in those started on amikacin than in those treated with capreomycin only.
• Amikacin seemed associated with less hypokalemia than capreomycin (odds ratio, 0.28; 95% CI, 0.11 to 0.72), with 5 of 37 (14%) patients stopping capreomycin due to recurrent electrolyte loss.
• No difference regarding the number of patients experiencing a rise in the creatinine level of >1.5 times the baseline level were evident.