Factors Influencing Tuberculosis Treatment Outcome in Adult Patients Treated with Thrice-Weekly Regimens in India

Abstract

The Indian Revised National Tuberculosis (TB) Control Programme uses thrice-weekly treatment with standard drug dosages. The role of plasma drug levels and other factors in determining TB treatment outcomes is not well understood. We aimed to determine the factors influencing the concentrations of rifampin (RMP), isoniazid (INH), and pyrazinamide (PZA) at 2 h postdosing in adult TB patients and to study the factors impacting TB treatment outcome. We recruited 1,912 adult TB patients (newly treated and retreated patients) with pulmonary/extrapulmonary TB receiving antitubercular treatment (ATT) in the RNTCP in Chennai, India. At steady state, the concentrations of RMP, INH, and PZA were determined at 2 h postdosing after supervised drug administration. A total of 1,648 patients had a favorable outcome, while 264 (14%) had an unfavorable outcome. A total of 91%, 16%, and 17% of the patients had suboptimal concentrations of RMP (Ͻ8 g/ml), INH (Ͻ3 g/ml), and PZA (Ͻ20 g/ml), respectively. Factors associated with treatment outcome were low RMP concentrations (adjusted odds ratio [aOR], 0.94; 95% confidence interval [CI], 0.89 to 0.99; P ϭ 0.036), category II ATT (aOR, 2.39; 95% CI, 1.56 to 3.65; P Ͻ 0.001), low body weight (aOR, 0.96; 95% CI, 0.94 to 0.98; P Ͻ 0.001), alcohol use (aOR, 2.17; 95% CI, 1.42 to 3.31; P Ͻ 0.001), male gender (aOR, 1.92; 95% CI, 1.02 to 3.62; P ϭ 0.043), and baseline INH resistance (aOR, 5.74; 95% CI, 3.12 to 10.59; P Ͻ 0.001), which significantly increased the likelihood of an unfavorable outcome in multivariate logistic regression analysis. Further studies are needed to optimize anti-TB drug dosages and improve cure rates. Drug susceptibility testing at the baseline and attention to undernutrition and alcohol dependence are other important interventions.

Treatment outcomes of patients with tuberculosis in war affected region of Khyber Pakhtunkhwa, Pakistan

“…In this study, the overall TB treatment success rate is higher from previous published studies in different countries; studies from India reported the overall treatment success rates were (81%) [23], (83%) [24], (84.21%) [25], and (86%) [26], in Thailand the success rate was (78.5%) for patients in the TB Case Management cohort, while the success rate is high (87.5%) for patients in the National Health Security Office cohort [27], Iran (83.1%) [28], Uzbekistan (83%) [29], Denmark (80.5%) [30], Malaysia (67.26%) [31], Ethiopia (85.6%) [32], Somalia (81.8%) [33], Nigeria (83.1%) [34], in…”

Sexual dimorphism in bacterial infections

“…Furthermore, the plasmatic levels of the anti-tuberculosis drugs, isoniazid, and pyrazinamide are lower in adult males than in females. This could be related to the worst outcome in the treated males [ 108 ]. Interestingly, this higher proportion of affected males is not observed in children or young adolescents, suggesting the participation of sex hormones in the pathogenesis of tuberculosis [ 109 , 110 ].…”

Treatment outcome in tuberculosis patients under DOTS treatment, tuberculosis unit, Nahan, Himachal Pradesh, 2013-2015: a record based descriptive study

“…[19][20][21] Ramachnadran et al study at Chennai revealed cure rate of 79% in smear positive TB patients. 28 The cure rate after completion of DOTS treatment was 85.5% (279/326) for category I and 67.7% (105/155) for patients. The cure rates are comparable to a study from Delhi that reported treatment success rate in category I and category II patients as 91.0% and 73.0%, respectively.…”