Delphi Survey on the Current and Future Korean Guidelines for Isoniazid-Monoresistant Tuberculosis

Wan Seo; Hyung Woo Kim; Eung Gu Lee; Tai Joon An; Seunghoon Kim; Yun-Jeong Jeong; Sang Haak Lee; Yeonhee Park; Jeongha Mok; Jee Youn Oh; Yousang Ko; Sun-Hyung Kim; Sun Jung Kwon; Sung Soo Jung; Jin Woo Kim; Ju Sang Kim; Jinsoo Min

doi:10.2147/IDR.S420830

Delphi Survey on the Current and Future Korean Guidelines for Isoniazid-Monoresistant Tuberculosis

Infect Drug Resist. 2023 Aug 11:16:5233-5242. doi: 10.2147/IDR.S420830. eCollection 2023.

Authors

Wan Seo¹, Hyung Woo Kim², Eung Gu Lee³, Tai Joon An⁴, Seunghoon Kim⁵, Yun-Jeong Jeong⁶, Sang Haak Lee⁷, Yeonhee Park⁸, Jeongha Mok⁹, Jee Youn Oh¹⁰, Yousang Ko¹¹, Sun-Hyung Kim¹², Sun Jung Kwon¹³, Sung Soo Jung¹⁴, Jin Woo Kim¹, Ju Sang Kim², Jinsoo Min¹⁵

Affiliations

¹ Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
² Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
³ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
⁴ Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
⁵ Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, St. Vincent's Hospital, College of Medici ne, The Catholic University of Korea, Seoul, Republic of Korea.
⁶ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea.
⁷ Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
⁸ Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
⁹ Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea.
¹⁰ Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
¹¹ Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Republic of Korea.
¹² Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea.
¹³ Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Konyang University Hospital, Daejeon, Republic of Korea.
¹⁴ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea.
¹⁵ Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Abstract

Purpose: Isoniazid-monoresistant tuberculosis (Hr-TB) has emerged as a global challenge, necessitating detailed guidelines for its diagnosis and treatment. We aim to consolidate the Korean guidelines for Hr-TB management by gathering expert opinions and reaching a consensus.

Patients and methods: A conventional Delphi method involving two rounds of surveys was conducted with 96 experts selected based on their clinical and research experience and involvement in nationwide tuberculosis studies and development of the Korean guidelines on tuberculosis. The survey consisted of three sections of questionnaires on diagnosis, treatment, and general opinions on Hr-TB.

Results: Among the 96 experts, 72 (75%) participated in the two rounds of the survey. A majority of experts (96%) strongly agreed on the necessity of molecular drug susceptibility testing (DST) for isoniazid and rifampin resistance in all tuberculosis patients and emphasized the importance of interpreting mutation types (inhA or katG) and additional molecular DST for fluoroquinolones for confirmed isoniazid-resistant cases. Over 95.8% of experts recommended treating Hr-TB with a combination of rifampin, ethambutol, pyrazinamide, and levofloxacin for six months, without exceeding 12 months unless necessary. They also acknowledged the drawbacks of long-term pyrazinamide use due to its side effects and agreed on shortening its duration by extending the duration of the rest of the treatment with a modified combination of choice.

Conclusion: This Delphi survey enabled Korean tuberculosis experts to reach a consensus on diagnosing and treating Hr-TB. These findings will be valuable for developing the upcoming revised Korean guidelines for Hr-TB management.

Keywords: delphi technique; isoniazid-resistance; tuberculosis.

Grants and funding

This work was supported by the Research Program funded by the Korea National Institute of Health [grant number 2022E200100]. The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.