Outcome in multi-drug resistant tuberculosis patientswith ambulatory treatment.

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.