Outcome in multi-drug resistant tuberculosis patientswith ambulatory treatment.
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Date
2004-01
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Abstract
Background: Multidrug resistant tuberculosis (MDR-TB) is emerging as an increasingly important cause of
morbidity and death. The patients continue to spread disease for a prolonged period and may pose a threat to the
success of DOTS.
Aim: To evaluate response to chemotherapy with second line drugs given on domiciliary basis in cases of MDRTB.
Methods: Retrospective case records of 36 proven MDR-TB patients treated from April 1998 to April 2001 were
analyzed. The patients were defined as cured when they had continued to be smear and culture negative for more
than one year in addition to clinical and radiological improvement. All patients were followed up for relapse for
one year.
Results: Out of 36 patients, 27 had far advanced lesions and 8 had moderately advanced lesions. All patients had
resistance to at least Isoniazid and Rifampicin. Additional resistance was observed to Streptomycin in 19,
Pyrazinamide - 8, Ethambutol - 8, Ethionamide - 6, Cycloserine - 5, Thiacetazone - 4, Ciprofloxacin- 3 and PAS
in one patient. Average duration of pre-treatment chemotherapy was 14 months. Twenty patients were cases of
relapse. Ten patients had concomitant disease (NIDDM - 3, COPD-4, Bronchial asthma-2, IHD-1). Average time
for sputum conversion was 5 months. Twenty-three patients had sputum conversion in less than 4 months after
revised chemotherapy. Out of 36 patients, 28 patients were declared cured at the end of 24 months of therapy,
7 patients defaulted and one patient died due to massive haemoptysis. Adverse reactions to chemotherapy included
photosensitivity to Sparfloxacin-4 patients, ototoxicity to Kanamycin-2 patients and hyperuricemia- one patient.
Conclusion: Problem of MDR-TB can be managed to some extent by ambulatory treatment with other logistic
supports like drugs, laboratory services and sympathetic motivated staff.
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Keywords
MDR-TB, DOTS
Citation
Rai S P, Panda B N. Outcome in multi-drug resistant tuberculosis patientswith ambulatory treatment. Indian Journal of Tuberculosis. 2004 Jan; 51(1): 33-36.