The article presents economic feasibility evaluation for using high-priced drugs in the regimens for treatment of tuberculosis patients with extensive drug resistance.

Subjects and Methods. Treatment efficiency was evaluated in 175 tuberculosis patients with extensive drug resistance, treated by four different regimens, including third line drugs and without them; the economic impact of each regimen was evaluated. Two types of pharmaco-economic analysis were used: costs – effectiveness and budget impact analysis.

Results of the study. Despite the significant costs of regimens containing moxifloxacin, linezolid, and bedaquiline, the co-efficient of costs – effectiveness turned out to be the lowest. When using models for comparing costs and losses over 5 year period of XDR TB patients treatment it was found out that regimens containing moxifloxacin, linezolid and bedaquiline possessed significant economic predominance which required major investment at the initial stages of introduction, and by the end providing savings from 46.3 to 65.3% of the budget compared to the regimens without these drugs. The obtained results provide the evidence that use of regimens containing new highly effective drugs (moxifloxacin, linezolid and bedaquiline) in rational combinations with basic and reserve drugs, prescribed with consideration of drug resistance profile allow achieving the significant economic effect. 

The article characterizes respiratory tuberculosis in adolescents exposed to tuberculous infection. Exposure to tuberculosis in the family or when contacting close relatives makes the biggest contribution into development of the disease unless the patient is isolated from those exposed. Advanced and severe forms of tuberculosis with bacillary excretion are detected, compromising the life quality of adolescents. The main causes of late diagnostics are poor performance of TB services, primary medical units, low level of health education aimed at the increase of motivation to have planned medical examinations in the general population and to take relevant sanitary and hygienic measures in the sites of infection. Adolescents from the sites with bacillary excretion, and, first of all, if multiple or extensive drug resistant tuberculosis is detected, are to be considered a high priority group facing the risk to develop the disease with more frequent monitoring and deeper examination. In primary medical units, should any sings typical of tuberculosis be presented, it is sensible to add skin tests (Mantoux test and test with tuberculous recombinant allergen) to the minimum diagnostic procedures. Organizational, methodical and health education activities in the sites of infection are to be improved.

The objective: to provide clinical and epidemiological characteristics of extrapulmonary tuberculosis and develop simultaneous rapid diagnostics of tuberculosis and drug susceptibility based on molecular genetic and bacteriological tests of non-respiratory samples and resection (tissue) materials. Statistic reports on tuberculosis for 2016 were analyzed, as well as materials of electronic register Tuberculosis in order to assess extrapulmonary tuberculosis incidence and its structure. Surgery was performed in 20 extrapulmonary tuberculosis patients, non-respiratory samples and tissue were obtained in order to isolate DNA of tuberculous mycobacteria. Still, there is a significant number of extrapulmonary tuberculosis patients who remain undetected. On the other side, it is possible to state that there is overdiagnosis of extrapulmonary tuberculosis. The high efficiency of GeneXepert MTB/RIF for testing of resection materials received through surgical treatment of extrapulmonary tuberculosis has been proved. This method allowed detecting DNA of tuberculous mycobacteria in biological specimens fast (within 2 hours) and also testing drug susceptibility to rifampicin. Results of rifampicin susceptibility testing, received by culture and GeneXpert MTB/RIF are compatible. Due to this, it is possible to amend treatment regimens in a timely manner.

The article presents results of multi-dimensional analysis of 83 rates, calculated on the basis of federal and sectoral reports on tuberculosis in 21 regions of Siberian and Far Eastern Federal Districts, which were collected from 2006 to 2016. For statistic processing of data, a distance matrix was used with its consecutive analysis by principal coordinates analysis, which allowed detecting the closest correlations between rates. It has been proved that main factors of successful tuberculosis control are the following: improvement of the organizational quality of treatment and diagnostics, provision with qualified medical personnel, early detection through expansion of coverage of population with fluorography screening. The principal coordinates method also allowed performing a multilateral evaluation of epidemic situation in all regions and defining the ones with the most favorable tuberculosis situation.

The objective of the study: to evaluate the possibility to enhance the clinical efficiency of treatment of pulmonary tuberculosis patients by adding bedaquiline to the fifth chemotherapy regimen.

Subjects and methods. The presented results were obtained through dynamic follow-up and treatment of 68 respiratory tuberculosis patients, treated in St. Petersburg TB Dispensary from 2014 to 2016.

Results. The clinical improvement manifested through relief of intoxication symptoms, normalization of blood count, reduction of infiltrate changes and healing of destruction. In a number of cases, relief of intoxication symptoms with reduction of bacillary excretion massiveness, infiltration and cavity sizes allowed preparing patients for the next stage of treatment – surgery. 

The article describes the safety and efficiency evaluation of chemotherapy regimens containing bedaquiline used in 23 tuberculosis patients with multiple and extensive drug resistance in Amur Region. Treatment with bedaquiline (24 weeks) and other anti-tuberculosis drugs was highly effective based on sputum conversion criteria: sputum microscopy – 86.7% (13/15; 95% CI 62.1-96.3%), culture ‒ 82.6%, (19/23; 95% CI 62.7-93.0%), and cavity healing ‒ 73.9% (17/23; 95% CI 53.6-87.5%), of them patients with previous treatment failure made 43.6% (10/23). The best outcomes were achieved in the patients with new tuberculosis and relapses. A satisfactory safety profile was demonstrated during this trial piloting chemotherapy regimens containing bedaquiline, no cardiac toxicity was registered.

The objective of the study: to assess the impact of continuous and course (intermittent) use of pyridoxine hydrochloride in combination with isoniazid on the rate of tolerance development in rats under conditions of a toxicological experiment.

Subjects and methods. Isoniazid (tablets, 0.3 g.) and the substance of pyridoxine hydrochloride (powder, 50.0 g.) were used for the experiment. Male white rats were used as experimental biological models.

Main results. The article presents data on experimental study of toxicologic tolerance of rats to the anti-tuberculosis drug of isoniazid with its administration simultaneously with pyridoxine hydrochloride. The obtained data provided the evidence about the impact of pyridoxine hydrochloride on the rate of how fast the host developed the tolerance to the toxic action of isoniazid. It has been proved that intermittent (by short courses) use of pyridoxine hydrochloride with isoniazid versus its continuous use resulted in a slower development of toxicological tolerance to isoniazid in rats. 

The article describes a clinical case of the successful management of pregnancy, delivery and post-natal period in the female patient with fibrous cavernous tuberculosis with extensive drug resistance and multiple thoracic surgeries in the past. This clinical case demonstrates that it is possible for a mother with the advanced form of tuberculosis to give birth to a healthy mature newborn.