Treatment outcome of multidrug-resistant tuberculosis with modified DOTS-plus strategy: A 2 years' experience

Abstract

Background: Multidrug-resistant tuberculosis (MDR-TB) is a global health problem with notoriously difficult and challenging treatment. This study determined treatment outcome in patients of MDR-TB with modified DOTS-Plus strategy. Methods: Ninety-eight consecutive MDR-TB patients treated with standardized regimen according to modified DOTS-Plus strategy aligned to the existing national DOTS-Plus guidelines with relevant modifications proposed by Chennai consensus were analyzed prospectively. Treatment included monthly follow-up with clinical, radiological, and bacteriological assessment (sputum smear advised monthly till conversion then quarterly; culture for Mycobacterium tuberculosis at 0, 4, 6, 12, 18, and 24 months), ensuring adherence, intense health education, and monitoring of adverse events (AEs). Patients' outcome was considered as cure when at least two of the last three cultures (all three or last two) were negative and as failure when the same were positive. Results: Favorable and unfavorable outcomes in this cohort were reported to be 71/98 (72.4%) and 27/98 (27.6%) (failure – 10 [10.2%], default – 7 [7.1%], and expiry – 10 [10.2%]), respectively. Sputum smear and culture conversion rate were 75/81 (92.5%) and 71/81 (87.7%), respectively. Major AEs were experienced in only 17.4% of patients. Conclusions: MDR-TB can be cured successfully with modified DOTS-Plus strategy and requires much effort from both the patients and health-care workers. It can be an alternative model for treating MDR-TB patients in private sector.

To study the profile of multi-drug resistant tuberculosis (MDR) TB patients on shorter regimen at a tertiary care Centre of North India

“…Singh et al in their study found Unilateral in 5(5.1%) cases and Bilateral in 93(94.9%) cases, however he reported most common finding was consolidation 70(71.4%) in his study. 9 In the present study, out of 93 patients, sputum microscopy conversion was 87.1% (n=81/93), 95.7% (n=89/93), 98.9% (n=92/93), 100% (n=93/93) at 3-month, 4-month, 5 month, and 6 month respectively. While culture conversion at 3 month was 95.7% (n=89/93).…”

“…The association between treatment outcome and age group, gender were not significant (P=0.113, 0.323 respectively), similar observation reported by other previous studies. 8,9 In the present study, 66(71%) patients had BMI <18.5kg/m 2 while 27(29%) had BMI 18.5-24.9kg/m 2 . Mean BMI was 17.3±2.1 (range=12.…”

“…However Singh et al found 13(13.3%) patients were alcoholics and 4(4.1%) patients were diabetics in his study. 9 In this study 10(10.8%) patients were diabetics, 10(10.8%) patients were COPD, 7(7.5%) patients were asthmatics and 2(2.2%) patients had HIV, The association between treatment outcome and comorbidity was not significant (p value=0.091). In this study Chest X-ray finding were unilateral in 2(2.2%) cases and bilateral in 25(97.8%) and the most common radiological finding was nodules in 25 (26.9%) cases .The association between treatment outcome and X-ray finding were not significant (p value=0.909).…”

“…8 Singh et al in their study found that sputum smear and culture conversion rates were 75/81 (92.5%) and 71/81 (87.7%), respectively. 9,11 In other previous studies also culture conversion rates were in between 74% to 92%. [11][12][13][14] In this study, out of 93 patients 76.3% were cured and 23.7% were failed treatment.…”

“…So sputum smear conversion and culture conversion rates of our study were in concordance with other studies. 8,9 Aung KJM et. reported culture conversion in 93% cases at 2 month of treatment while microscopy were also negative at 4 month in more than 90% patients.…”