PURPOSE: The purpose of the study was to see the clinical efficacy of a combination therapy with capreomycin, azithromycin and other second-line anti-tuberculosis drugs in the treatment of multi-drug resistant pulmonary tuberculosis (MDR-TB).
METHODS: Forty-seven patients (study group), aged 18 years to 50 years having multi-drug resistant tuberculosis (MDR-TB) were given capreomycin, azithromycin along with pyrazinamide, ethionamide, cycloserine and ethambutol under direct supervision. Forty-five patients (control group) were given kanamycin, pyrazinamide, ethionamide, cycloserine and ethambutol. All patients were HIV negative, smear-positive, non-pregnant and had been receiving anti-tuberculosis drugs for an average of 74 weeks (30 to 138 weeks). All patients had isolates resistant to both isoniazid and rifampicin. Capreomycin was given in the dose of 15 mg/kg body weight for 24 weeks. Pyrazinamide was given for full course of therapy.
RESULTS: Forty-three cases in the study group and 42 in the control group completed the treatment. The sputum negative conversion in the study group was 64% as compared to 57% in the control group. The radiological improvement rate was 36% in the study group as compared to 27% in the control group. The closure rate of the lung cavities in the study group was 49%. This was also not statistically significant when compared to the control group where cavity closure was in 45%.No significant difference was found in the side-effects between the two groups.
CONCLUSION: Chemotherapy with capreomycin, azithromycin, cycloserine, pyrazinamide, ethionamide and ethambutol was not more effective than combination of kanamycin, pyrazinamide, ethionamide, cycloserine and ethambutol.
CLINICAL IMPLICATIONS: Chemotherapy with kanamycin, cycloserine, pyrazinamide, ethionamide and ethambutol seems to be promising for Indian patients having MDR-TB.
DISCLOSURE: Sudhir Agarwal, None.