Multidrug resistant tuberculosis (MDR-TB) is an increasing worldwide problem which is notoriously difficult to treat and has greater risk of relapse. Our study analyzes the longterm treatment outcome with second line drugs in patients with MDR-TB.
A descriptive analyses of 39 consecutive patients with MDR-TB attending the department of Tuberculosis and Chest Diseases, King George Medical University, Lucknow, India between june 1998 to april 2002 with followup till april 2004. All patients were admitted for an average duration of 64 (15-136) days and received an individually tailored regimen essentially based on previous treatment history, chosen from Kanamycin, PAS, Ethionamide, Cycloserine, Flouroquinolone,Clofazimine. Kanamycin was used only for an average period of 4.2(2.5-6) months till sputum smear conversion, rest of the drugs continued for an average period of 20(18-25) months. Cure was defined when sputum culture was negative at the end of 2 year treatment.
All the patients had resistance to atleast isoniazid and rifampicin with resistance to mean no of 4 drugs. Average duration of pretreatment chemotherapy was 26.9 months. All the patients were sero-negative for HIV. Out of 39 patients enrolled, 31 completed the treatment as planned. 2 patients died during the treatment and 6 patients abandoned it or lost to follow up. Out of 31 who had completed the treatment, 28 were declared cured. Considering the best scenario (excluding the lost and expired patients) cure rate was 90%(28/31) and in worst scenario (considering the lost and expired patients as failure) cure rate was 71%(28/39). Out of 28 cured patients, 21 patients came for follow-up for mean duration of 16 (range:3-48) months. 3 out of 21 (14%) patients showed relapse. Significant side effect was experienced in 8(19%) patients.
MDR TB can be cured successfully and requires much effort from both the patients and health care workers.
Adequate combination of drugs for an adequate duration under supervision can cure MDR-TB.
R. Prasad, None.