A-cohort study on the standard short-course chemotherapy program for drug resistant tuberculosis in the rural counties in Eastern China / 中华流行病学杂志

ABSTRACT

Objective To investigate the therapeutic efficacy of short course chemotherapy (SCC)on drug resistant tuberculosis (DR-TB) cases and related influencing socioeconomic factors. TB patients registered in local county TB dispensaries of two rural counties were followed up in Deqing and Guanyun of Eastern China, during 2004/2005. Methods Culture-positive patients (Deqing: 182, Guanyun: 217)were selected as subjects of this study. A cohort of TB patients was established at the beginning of their treatment and each patient was followed-up three times by questionnaires. Proportional method of drug susceptibility test was used to define the resistance to the 1st-line anti-TB drugs.χ2 test Kaplan-Meier method and Cox analysis were applied in multivariate analysis to investigate the negative conversion of smear positive sputum, treatment result of SCC and its socioeconomic influencing factors. Results The cure rates of multi-drug resistant TB (MDR-TB),other drug resistant TB (ODR-TB) and pan-drug susceptible TB,were 58.3%, 91.0%, 98.7% and 51.3%, 89.5%, 93.5% respectively in Deqing and Guanyun. The liver dysfunction (RR = 0.18, 95% CI:0. 04-0. 69 ) and previous treatment history (RR = 0.26,95% CI:0.07-0.93) were associated with treatment result among MDR-TB. Result on treatment in ODR-TB was influenced by previous treatment history (RR = 0.66, 95% CI:0. 44-0. 98 ) and Patient delay (＞2 weeks)(RR = 0.67, 95% CI: 0.46-0.97). Conclusion The priority in treating MDR-TB would include:managing side effect, developing the fast sensitive drug susceptibility test and modifying the treatment regimen corresponding to drug resistance.