Improving treatment outcomes of tuberculosis: towards an antimicrobial stewardship program

Global tuberculosis (TB) disease burden has further worsened due to the increase of multidrug-resistant tuberculosis (MDR-TB). We therefore aimed to identify effective strategies for improving TB treatment outcomes. Our global meta-analytic study confirmed that being previously treated for TB and non-adherent to drug therapy are important risk factors of MDR-TB development. Effect modification by geographical area was identified for several risk factors of MDR-TB, which underlines that assessment of the risk factors should be conducted locally to develop the most effective strategies for MDR-TB control. Our studies in the Netherlands demonstrated that although treatment success of TB was high, particular vulnerable populations (i.e. homeless people, drug abusers, prisoners, migrants, diabetes, miliary, central nervous system and MDR-TB) were identified as the major drivers for continuing TB burden. In Indonesia, we identified that problems related to lack of TB knowledge, stigmatization, long distance to the health facility, adverse drug reaction and loss of household income, are the main barriers to successful TB treatment from the patient’s perspective. We suggest that an effective screening strategy and treatment program should be focused on the vulnerable populations in the Netherlands, while an integrated program to improve case detection and treatment outcome are essentially required in Indonesia. Regarding monitoring of medication adherence in TB treatment, prescription databases are useful and the application should consider local prescription system and quality of the database. Furthermore, a personalized intervention that takes into account individual factors should be developed for an effective TB medication adherence program.