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Efficacy and Safety of Unsupervised Chemotherapy at a Multi Drug Resistant Tuberculosis Center in India FREE TO VIEW

Ashok K. Janmeja, MD*
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Government Medical College, Chandigarh, India


Chest. 2004;126(4_MeetingAbstracts):833S. doi:10.1378/chest.126.4_MeetingAbstracts.833S-a
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PURPOSE:  A sizable population of multi drug resistant tuberculosis [MDR-TB] patients exists in India. Revised National Tuberculosis [TB] Control Program using DOTS caters all kind of TB but the MDR. The management of MDR-TB despite being challenging, difficult, and expensive carry poor prognosis. WHO recommends that such patients be managed by experts at specialized MDR centers. So as to have a clear insight about outcome of patients being treated at our MDR-TB center, we retrospectively analyzed their records.

METHODS:  We evaluated 60 patients registered at our center, [01.01.1999 -11.02.02]. The diagnosis was confirmed by culture and sensitivity depicting resistance to a minimum of isoniazid [H] plus rifampicin[R]. After base line liver and renal functions and having counseled patients and their families on anticipated problems, standard WHO regimens for MDR-TB were started on domiciliary basis. Patients were followed fortnightly during intensive phase [IP] and monthly during maintenance phase [MP] for general condition, adverse effects etc. Sputum smear and culture was done monthly during IP and quarterly there after. Chest X-Ray was done initially, on completion of IP and of MP. Compliance was assessed by pill counting and checking empty wrappers.

RESULTS:  Among 60 patients of 15 -60 years of age, male to female ratio was 2:1 and majority belonged to lower economic strata. All were HIV negative, 58 had pulmonary and 4 extra pulmonary TB. Most had taken 3-5years of prior chemotherapy. Fifty patients revealed resistance to 2-3 drugs [H, R, Streptomycin], resistance to more drugs was low and uncommon to reserve drugs. Sputum converted in 70% cases within 2- 8 months of chemotherapy, 18.3% had treatment failure, 21.6% defaulted and 11.6% died.

CONCLUSION:  Overall cure rate under unsupervised chemotherapy at MDR-TB centre was 66.6%, however, default rate [21.6%], mortality rate [11.6%], and failure rate [18.3%] was high. Drug toxicity occurred in 20% cases.

CLINICAL IMPLICATIONS:  The cure rate under unsupervised chemotherapy is quite favorable; however, it can possibly be further improved if treatment is given under direct observation.

DISCLOSURE:  A.K. Janmeja, None.

Wednesday, October 27, 2004

12:30 PM - 2:00 PM




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