Chest Infections: Atypical Chest Infections |

Treatment Outcome of TB in Sohag Governorate: Directly Observed Therapy Compared With Self-Administered Therapy FREE TO VIEW

Hamdy Mohammadien, MD; Hamed khalifa, MD; Eman Abdel El-Baset, MD
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Sohag Faculty of Medicine, Sohag University, Egypt, Sohag, Egypt

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):112A. doi:10.1016/j.chest.2016.08.121
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SESSION TITLE: Atypical Chest Infections

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 23, 2016 at 01:30 PM - 03:00 PM

PURPOSE: To evaluate the effectiveness of DOT for tuberculosis treatment in a retrospective& prospective study and compared treatment outcomes among smear positive and smear negative pulmonary cases and extrapulmonary TB cases in Sohag Governorate from 2008 through 2015.

METHODS: All patients with tuberculosis registered for treatment from 1 January 2008 to 31 December 2015 were included in the study. Information was extracted from their medical records at treatment commencement and at 6 and 9 months after treatment was instigated. Data gathered included demographic data, site of disease, case category, treatment regimen, bacteriological status, and treatment outcome. Among the 2992 cases evaluated, 1144 (38.2%) were new patients with a positive sputum smear, 339 (11.3%) were patients who were retreated with a positive sputum smear, 398 (13.3%) were new or retreatment patients with a negative sputum smear, and 1111(37.1%) were new or retreatment patients with extrapulmonary TB. 2412 of patients were enrolled in DOT and 580 in self-administered therapy (SAT).

RESULTS: There were 2992 patients for analysis. Approximately 51% of patients were aged between 20-39 years, and 51.4% were male. Pulmonary disease alone occurred in 62.8% of patients, extrapulmonary TB occurred in 37%, while both pulmonary and extrapulmonary diseases occurred in 0.2%. New patients comprised 87% of cases. Patients treated by directly observed therapy at the start of therapy (n=2412) had a significantly higher cure rate compared with patients treated by self-administered therapy (n=580) (the sum of bacteriologic cure and completion of treatment, 85.8% versus 58.8%, p<0.0001). Among new smear-positive patients, treatment success was 88% DOT group vs 60.6% SAT group (81% vs 55% cure, 7% vs 5.7% completion); remaining outcomes were 4.3% vs 25.1% default, 2.2% vs 8% failure, 3% vs 3% death, and 2.6% vs 3.4% transfer. Rates of treatment failure, defaulted from treatment were significantly higher in SAT group compared with DOT group (3.3%, 33.6% versus 1.7%,7% respectively, p<0.03). The proportion of successful treatments differ significantly between the urban & rural patients under DOT and those under SAT (86.3%, 85.5% versus 73%, 49.8%, p<0.0001). In urban & rural patients under SAT there were (25.8% & 46.8 %) potentially unsatisfactory outcomes (treatment failure, defaulted from treatment, transfer out) compared with (10.5% & 11.5%) of those under DOT p<0.002).

CONCLUSIONS: We conclude that treatment plans that emphasize directly observed therapy from the start of therapy have the greatest success in improving tuberculosis treatment outcomes, thus DOT was significantly superior to the self-administered regimen.

CLINICAL IMPLICATIONS: Successful treatment of tuberculosis especially sputum +ve pulmonary TB reduce risk of infection and appearance of new cases and drug resistant cases. DOT allaw good adherance to TTT of TB.

DISCLOSURE: The following authors have nothing to disclose: Hamdy Mohammadien, Hamed khalifa, Eman Abdel El-Baset

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