This systematic review and meta-analysis tested the hypothesis that inappropriate tuberculosis (TB) regimens are a risk for development of multidrug resistant tuberculosis (MDR-TB).

A search was conducted of Medline, Embase and other databases for cohort studies including TB patients who received treatment. Data on treatment regimen, drug susceptibility testing results and genotyping results before treatment and at failure or relapse were abstracted from the included articles.

Overall four studies were included in the systematic review, of which two could be included in the meta-analysis. The findings from these 2 studies indicated that the risk for development of MDR-TB in patients who failed treatment and used an inappropriate treatment regimen was increased 27-fold (26.7, 95% CI, 5.0 to 141.7) compared to individuals who received an appropriate treatment regimen.

The researchers conclude that this finding supports the general opinion that inadequate treatment is a risk factor for the development of drug-resistant TB and MDR-TB, though they note that only two studies provided data for the meta-analysis. They suggest “this information can be used to advocate for adequate treatment for patients based on drug resistance profiles.”