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Outcome of 66 patients with Multi-Drugs Resistant(MDR)TB Treated with DOTS Plus Regimen: South- East area, Ahmadabad Experience

Kapadia Vishakha K and Tripathi Sanjay B.

To analyze demographic, clinical, radiological and bacteriological profile, drug sensitivity pattern, adverse drug reactions and treatment outcome in MDR TB patients treated with DOTS plus regimen. From August 2007 to March 2010, 66 patients who were on DOTS plus regimen were analyzed retrospectively. Data collection was from treatment cards and medical records. Sputum smear and culture examination for tubercle bacilli were performed every month in intensive phase (IP) started at the end of third month and then every third month in continuation phase (CP) until end of treatment. Serum creatinine was measured every month in IP and quarterly in CP. Regular chest radiography was done at commencement of therapy, at the end of intensive phase and at the end of treatment. Weight was done at regular interval. Clinical assessment made regularly for clinical improvement and tolerance of drugs. All data compiled and meta-analysis was done for outcome profile and various factors leading to adverse outcome. Data were expressed in means ± SD and ranges. Comparison of the success and failure/default/death/treatment completed groups was made using Student’s independent samples t tests for numeric variables and x2 test for categoric variables. A p value, 0.05 was considered significant. 25 patients (37.87%) were cured, 4 patients (6.06%) failed, 17 patients (25.75%) defaulted and 17 patients (25.75%) died and 3 patients (4.54%) had completed treatment (TC) of total 66 patients who were put on CAT IV treatment. Mean time for sputum smear and culture conversion were 4.2±2.2 and 4.29±2.5 months, respectively. Extensive lung lesion, cavitations, poor adherence to treatment, high initial bacterial load and BMI less than 18 are variables associated with poor treatment outcome. 40 (60.60%) patients experienced adverse drug reactions and 18 of them required drug modifications. Initial drug sensitivity pattern, sputum smear and culture conversion at end of third and fourth month are not indicators to predict outcome. Sputum smear and culture conversion are very well correlated with clinical and radiological improvement. More emphasis should be given to reduce default and death rate to achieve good cure rate.