Chest Infections: Tuberculosis |

Treatment Response and Adverse Drug Events in Rifampicin Resistant TB Patients on Second Line Anti-Tubercular Treatment in a Tertiary Care Center of Western India FREE TO VIEW

Mani Tiwari, MBBS; Mahendra Patel, MD
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Government Medical College, Surat, India

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

Chest. 2016;150(4_S):207A. doi:10.1016/j.chest.2016.08.216
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SESSION TITLE: Tuberculosis

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: This study was done to know the bacteriological and radiological response of second line ATT (Category IV regimen), Adverse drug reactions (ADR) and Death and default rates during one year of treatment.

METHODS: Retrospective study was carried out in a tertiary care center of Western India, 308 confirmed Drug Resistant TB patients diagnosed by CBNAAT were enrolled under RNTCP Category IV (MDR-TB) regimen. Bacteriological follow up was done as per RNTCP schedule and Chest X-rays done at baseline, 6 months and 12 months were taken into consideration to evaluate the response to treatment. ADR during this period were vigilantly documented.

RESULTS: Out of 308 patients enrolled for study 67% were males and majority (79%) were of age group 18-45 years. Among Study participants, 97% had Pulmonary DR- TB, out of them 11.7% had Primary while 88.3% had Acquired Drug Resistance. Among Study participants various comorbid condition were present among which Diabetes, HIV-AIDS & Hypertension were more common. Radiological findings showed 74% of Pulmonary DR-TB patients having bilateral lesion, 56% of the lesions were cavitatory and 60% of patients had moderately advanced disease. At the End of 1 year, 231 chest radiographs were available for comparison. Positive response was noted among 183 radiographs with 181 of these having simultaneous favourable bacteriological response suggesting strong correlation (p<0.001). Sputum culture conversion at different time intervals was seen among 80.6% of patients with a mean duration of 4.06 ±0.95 months. At the end of 1 year of Cat-IV regimen treatment, 209 cases had favourable bacteriological response while 22 had poor bacteriological response, 27 died and 41 defaulted the treatment. Minor ADR were present in 81% (249) of the patients among which nausea, vomiting and arthralgia were more common while rest 39% (120) patients experienced major ADR like hypokalemia which were life threatening and demanded withdrawal of offending drug.

CONCLUSIONS: Priority should be given to strengthen the existing DOTS programme to prevent the rapid emergence of Drug-Resistant TB. Timely diagnosis and intervention for the management of ADR along with proper counselling and education of the patients and their family members is mandatory and should be implemented at each and every level of health care system.

CLINICAL IMPLICATIONS: Acquired Drug Resistance can chiefly be attributed to poor adherance to treatment. Sputum Culture conversion after 3-5 months of treatment initiation indicates the importance of intensive phase of treatment to render the patient non-infectious. Adverse drug reactions demand vigilant monitoring during treatment for prompt intervention and management.

DISCLOSURE: The following authors have nothing to disclose: Mani Tiwari, Mahendra Patel

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