PURPOSE: Multidrug resistant tuberculosis is emerging as a significant burning problem in India. At the same time, it is becoming clinical challenge to the treating physician. The incidence of MDR Tuberculosis is increasing day by day, which would mean a lot of expenditure. The drugs are more toxic, expensive and should be given for longer duration.
METHODS: In the present study, 64 cases of confirmed MDR Pulmonary Tuberculosis presented to our hospital between Jan 2004 and Dec 2005 were enrolled. Depending on the drug sensitivity pattern, some of the first line drugs (other than Isoniazid and Rifampicin) and three or more reserve drugs, (Kanamycin / Para-amino salicylic acid (PAS) / Prothionamide / Ethionamide / Cycloserine / Levofloxacin) were used as per the guidelines and recommendations for the management of MDR TB. All the drugs were provided free of cost at our hospital for the entire duration. Clinical outcomes were monitored by weight, sputum for AFB (Direct Smear), sputum culture for mycobacteria, and biochemical tests periodically.
RESULTS: 94% sputum smear conversion and 92% culture conversion were achieved at the end of 2 years of treatment. 7 patients developed hypothyroidism, 1 patient developed convulsions, and 1 patient developed psychosis and 2 patients developed severe drug rash. Most of the patients developed nausea during initial few months of treatment. 9 patients expired during initial few months of treatment due to extensive disease, unrelated to drug toxicity. 5 patients were dropouts.
CONCLUSION: Patients treated with second line drugs had good improvement in weight and sputum conversion at the end of 2 years treatment.
CLINICAL IMPLICATIONS: Treatment of Multi drug resistant Pulmonary tuberculosis with second line drugs is effective and most rewarding and can be included in Revised National Tuberculosis control program.
DISCLOSURE: Subhakar Kandi, None.