PURPOSE: To determine treatment outcomes at National Institute of Respiratory Diseases (INER) in TBP patients with previous antituberculosis treatment.
METHODS: Culture positive TBP patients with previous treatment admitted atINER from 1994 to 2001 were included. Study design: Retrospective study with revision of patient’s clinical charts. We analyzed INER treatment outcomes according to the number of previous treatments (1, 2 and 3 or more); to previous failure; to first INER treatment failure and to MDR-TB. INER treatment was given at primary care facilities and consisted in the follow-up of patients.
RESULTS: Of 146 patients, 56 had one, 54 had two and 36 had 3 or more previous treatments. INER outcomes: cure 68.2%, 40.4% and 68.8% (p=.009); default: 6.8%, 4.3% and 3.1% (p=.7) and failure 18.2%, 27.7% y 25.0% (p=.6), for each group, respectively. MDR-TB rate was 64.4%, 86.3% y 94.4% (Trend X2 p =.0004), for each group, respectively. Comparison among patients with or without previous failure before to INER admission (64 versus 81 patients), shown an association with first INER treatment failure [31.7% versus 16.1%, RM=2.4 (95%IC .9-6.4) p=.04]. Comparison among patients with and without failure to first INER treatment (32 versus 95 patients) shown: cure 16.1% versus 72.5% (p<.0001) and failure: 67.7% versus 7.7% (p<.0001) for the first and second groups, respectively. Of 133 patients with susceptibility tests (INER) (108/133) 81.2% shown isoniazid and rifampin resistance. Comparison among patients with or without MDR-TB (108 versus 25) shown cure of: 51.1% versus 72.7% (p=.07)and failure of: (25.5% versus 22.7%, p=.8), for each group, respectively. The cure rate in patients with monoresistance; multidrug resistance and poliresistance was of 71.4%, 44.9% y 30.8%, respectively (Trend X2 P=.03).
CONCLUSION: High cure rates among patients with previous treatment were observed (TB-MDR patients included), but the subjects with previous failure shown lower cure rates. The failure could be due to patients with primary TB-MDR.
CLINICAL IMPLICATIONS: It is possible to increase the cure rate through a better follow-up and education about TBP in treated patients.
DISCLOSURE: Dina Martinez Mendoza, None.