PURPOSE: India has been implementing Revised National Tuberculosis Control Programme (RNTCP), WHO-recommended Directly Observed Treatment Short Course (DOTS) to control tuberculosis (TB). The present study was undertaken to analyze outcome of Category III treatment in RNTCP received by patients having tuberculous cervical lymphadenopathy.
METHODS: 65, FNAC proven cases having tuberculous cervical lymphadenopathy received Category III regimen under RNTCP i.e. 2(HRZ) 3 / 4(HR) 3. The clinical response was noted at the end of treatment. Patients having no response or persistent lymphadenopathy underwent lymph node aspirate or lymph node tissue homogenate for Mycobacterial culture and sensitivity before receiving a re treatment regimen i.e. 2(SHERZ) 3 / 1(HER) 3 / 5(HR) 3, (Category II).
RESULTS: 41 out of 65 patients (63%) responded to Category III treatment, however, 24 patients (36.9%) did not showed response at the end of treatment. 16 patients (24.6%) showing no response with initial regimen, responded to re treatment regimen (Category II), while 5 patients (7.6%) turned out to be having drug resistant disease and responded with reserved drugs. Three patient required surgical resection of glands after completing the re treatment regimen.
CONCLUSION: Six months, thrice weekly, Category III regimen with three drugs in initial intensive phase seems insufficient treatment for patients having tuberculous cervical lymphadenopathy (only 63% response rate with about one fourth patients requiring re treatment regimen).
CLINICAL IMPLICATIONS: There is need for conducting large operational research, considering the number of drugs and duration of therapy in patients receiving Category III treatment for tuberculous cervical lymphadenopathy under RNTCP, especially in areas with primary drug resistance > 4%. Review and timely revision should be the essential component of any Tuberculosis Control Programme.
DISCLOSURE: Dr. Ramakant Dixit, None.