Treatment of tuberculous pleural effusion patients and their satisfaction with DOTS - 1½ year follow up.

ABSTRACT

Background: Under the Revised National Tuberculosis Control Programme, patients who are sputum negative after 3 smear examinations are subjected to radiological examination after they fail to respond to a course of antibiotics for a period of two weeks. Those showing radiological evidence of pleural effusion are examined physically and investigated further by tuberculin testing and diagnostic aspiration. Those confirmed to be suffering from tuberculous pleural effusion by naked eye examination, biochemical tests and cytology of pleural fluid are given a fixed schedule of drugs. The treatment is stopped after six or eight months as per category, and outcome is reported as “Treatment Completed”. Many a time, patients question the validity of stopping treatment without radiological examination. Physicians treating are also at times not confident themselves and often fail to reassure such patients. Presence of residual symptoms in such patients before stopping treatment creates further uneasiness among the treating physicians. Methodology and Results: A study carried out among 58 patients of TB pleural effusion, of which 36 (62.1%) could be followed for a period of 1½ years, revealed that 63.9% were satisfied with the DOTS policy of stopping treatment without x-ray at the end of treatment whereas 36.1% expressed dissatisfaction with this policy. As many as 16.7% even got their x-rays elsewhere before stoppage of treatment, for their own satisfaction. Conclusion: The 1½ year follow up revealed only one case of relapse i.e. a relapse rate of 2.8% after DOTS therapy. Almost all (97.2%) were, however, satisfied with the medicines dispensed under DOTS.