ABSTRACT
Background: Multidrug resistant tuberculosis (MDR TB) requires treatment with expensive, toxic, anti-tubercular drugs over a longer duration. Adverse drug reaction (ADR) to second line anti tubercular drugs affect compliance and hence treatment outcome. The primary objective of this study was to analyse ADRs and if these resulted in change or permanent suspension of drug. We also analysed treatment outcome, treatment adherence and co morbidities associated with MDR patients.Methods: A retrospective study was carried out at DOTS plus site in department of Pulmonary Medicine, Goa Medical College on registered MDR cases from November 2011 to October 2016. Socio demographic profile, diagnosis, treatment and ADRs were evaluated, ADRs were evaluated for frequency, causative drugs, management aspect and impact on treatment outcome.Results: Out of 201 MDR cases, 99 cases had 167 ADRs. Majority of patients having ADRs were in age group of 30-50 years with mean眘tandard deviation 36.82�.47, 59 (59.59%) males and 40 (40.40%) females, 92 (92.92%) retreatment cases and 7 (7.07%) newly diagnosed. Majority of ADRs were vomiting 31(18.56%), joint pain 31 (18.56%), gastritis 21 (12.57%), hearing impairment 16 (9.58%), numbness in leg 14 (8.38%), depression 12 (7.18%). Treatment outcome of cases with ADR was cured 45 (45.45%), treatment completed16 (16.16%), progressed to XDR 6 (6.06%), transferred out 5 (5.05%), defaulter 14 (14.14%), death 13 (13.13%).Conclusions: It is very important to recognise at the earliest and treat the ADRs with least modification of the treatment regimen to have a good treatment outcome.
ABSTRACT
Background: Between 2006 and 2015, the prevalence of MDR-TB has been found to be as high as 39.9% in some states. Approximately 35.8% of all previously treated patients developed MDR-TB. The objective of the present study was to identify demographic and health characteristics of patients as well as incidence and pattern of the adverse drug reactions caused by antitubercular drugs in MDR-TB patients in a tertiary care hospital of northern India.Methods: This 12 months study of observational study was conducted at a DOTS centre. MDR-TB diagnosed patients treated with DOTS Plus regimen were enrolled after getting informed consent. Patient information was recorded. Patient follow-up was conducted to identify the incidence and pattern of ADRs.Results: A total of 115 patients were enrolled. Maximum number of cases were in the 31-40 age group (25.21%) followed by the 41-50 age group (20.86%). 76 (66.08%) were males and 39 (33.91%) were females. 52 patients (45.21%) had concomitant diseases, out of which 15 (13.04%) were HIV positive and 21 (18.26%) were diabetic. 70 patients (60.86%) developed ADRs. The adverse drug reaction that were seen are -38 (38.76%) cases of gastrointestinal adverse drug reactions, 8 (8.16%) jaundice/hepatitis, 7 (7.14%) impaired hearing/vertigo, 21 (21.24%) central nervous system adverse drug reaction, 6 (6.12%) peripheral neuropathy, 6 (6.12%) rash and itching, 5 (5.10%) arthralgia, 3 (3.06%) renal impairment, 2 (2.04%) hypothyroidism and 2 (2.04%) blurred vision.Conclusions: Determining which population groups are affected most by ADRs can help physicians to better monitor and make an early diagnosis to reduce ADR-related morbidity and mortality.
ABSTRACT
Background: DOTS Plus site at LRS Institute, New Delhi, covering 1.8 million population. Aims: To ascertain if sputum smear could be used as a surrogate for culture during intensive phase of treatment of MDRTB patients thereby enabling early shift from intensive phase to continuation phase, reducing the need for frequent cultures and saving time and cost in their management. Methods: The study is a retrospective analysis of 138 MDR-TB patients on DOTS Plus treatment whose sputum samples were simultaneously subjected to smear microscopy and culture, monthly during Intensive Phase and once in two months during Continuation Phase. Sputum results in the treatment card were supplemented from laboratory register, if required, and analyzed. Predictive values, sensitivity and specificity of smear were compared with culture results. Results: The Negative Predictive Value (NPV) of smear was high from the 3rd month onwards (above 91%), at four months 98% or more and approached 100% from eight months onwards. The specificity of smear test gradually increased during treatment and from five months onwards, it was above 90%. Conclusions: Considerable correlation was observed between sputum smear and culture during follow up of DOTS Plus treatment in the Intensive Phase. Accordingly, sputum smears can be recommended instead of culture.
ABSTRACT
Multidrug-resistant tuberculosis (MDR-TB) is an increasing global problem. The extent and burden of MDR-TB varies significantly from country to country and region to region. Globally, about three per cent of all newly diagnosed patients have MDR-TB and the proportion is higher in patients who had previously received anti-tuberculosis (anti-TB) treatment reflecting the failure of programs designed to ensure complete cure of patients with tuberculosis. The management of MDR-TB is a challenge that should be undertaken by experienced clinicians at centers equipped with reliable laboratory services and implementation of DOTS-Plus strategy.