Adjunctive salvage therapy with inhaled aminoglycosides for patients with persistent smear-positive pulmonary tuberculosis

A proportion of patients with drug-resistant and drug-susceptible tuberculo sis (TB) have sputum that is smear and culture positive for Mycobacterium t uberculosis for a prolonged period of time, despite conventional therapy. A mong such patients with refractory TB, an unblinded, observational study wa s undertaken that used conventional TB therapy and adjunctive aerosol amino glycosides. Patients with persistent smear- and culture-positive sputum for M. tuberculosis (despite greater than or equal to2 months of optimal syste mic therapy) were selected for adjunctive treatment via inhalation with ami noglycosides, and microbiological responses were monitored. Thirteen of 19 patients converted to smear negativity during the study: 6 of 7 with drug-s usceptible TB and 7 of 12 with drug-resistant TB. Among patients with drug- susceptible TB, the median time to sputum conversion was 23 days, a shorter time than for a population of historical control patients. Recurrent infec tion was not observed. Adjunctive aerosol aminoglycosides may expedite ster ilization of sputum among certain patients with refractory TB and diminish the risk of transmission.