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Treatment Outcome of Multidrug Resistant Tuberculosis Patients in Modified DOTS-PLUS: A New Strategy - Two Years Experience FREE TO VIEW

Rajendra Prasad*, DSc; Abhijeet Singh, MD; Rahul Srivastava, MD; Ramawadh Singh Kushwaha, MD; Rajiv Garg, MD; Sanjeev Verma, MD; Amita Jain, MD
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U. P. Rural Institute of Medical Science and Research, Saifai, Etawah, India

Chest. 2012;142(4_MeetingAbstracts):144A. doi:10.1378/chest.1369137
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PRESENTED ON: Sunday, October 21, 2012 at 01:15 PM - 02:45 PM

PURPOSE: Multi Drug Resistant Tuberculosis is a worldwide problem and growing hazard to human health with notoriously difficult and challenging treatment. The study has been framed to know the treatment outcome with second line drugs in patients of MDR-TB in modified DOTS-PLUS strategy.

METHODS: A prospective cohort study analyzing 98 consecutive patients with MDR-TB attending the Dept of Pulmonary Medicine, CSMMU, between June 2009 to Feb 2010 with follow-up till February 2012.All the patients were given medications free of cost as per DOTS PLUS Protocol of Revised National Tuberculosis Control Programme (RNTCP). Treatment included monthly follow up, adherence check up, radiological and bacteriological assessment (sputum smear advised monthly till conversion then quarterly; culture for MTB at 0,4,6,12,18,24 months),intense health education and monitoring of adverse effects. Patients' outcome considered as 'cure' when atleast 2 of the last 3 cultures were negative and as 'failure' when the same were positive.

RESULTS: All the patients had resistance to at least Isoniazid and Rifampicin with mean no. of 3.02 drugs and were seronegative for HIV. Default rate at the end of 6 months, 12 months, 18 months and 24 months were observed to be 2.1%, 4.1%, 5.1% and 7.1% respectively. 10 (10.2%) patients expired at the completion of 24 months of treatment. Mean smear and culture conversion time were 3.4 ± 2.1 months (1-11) and 4.6 ± 2.5 months (4-12) respectively. Sputum smear and culture conversion at the end of 24 months were 75/81 (92.5%) and 71/81 (87.7%) respectively. Only 10 (10.2%) patients remained culture positive at the end of treatment.15 patients were considered to be XDR suspect (culture positive at the end of 6 months) of which only 2 of them were proved to be XDR-TB bacteriologically. Significant side effects were experienced in only 17.4% patients.

CONCLUSIONS: Culture conversion rate at the end of 24 months was 87.7%.Only 7.1% patients defaulted and 10.2% patients expired at the end of 24 months.

CLINICAL IMPLICATIONS: MDR TB can be cured successfully with appropriate combination of drugs for an adequate duration and requires much effort from both the patients and health care workers.Modified DOTS-PLUS strategy can be model for treatment of MDR-TB in private sector.

DISCLOSURE: The following authors have nothing to disclose: Rajendra Prasad, Abhijeet Singh, Rahul Srivastava, Ramawadh Singh Kushwaha, Rajiv Garg, Sanjeev Verma, Amita Jain

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U. P. Rural Institute of Medical Science and Research, Saifai, Etawah, India




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