How do patients who fail first-line tb treatment but who are not placed on an mdr-tb regimen fare in south india?

Abstract

Setting: Seven districts in Andhra Pradesh, South India Objectives: To a) determine treatment outcomes of patients who fail first line anti-TB treatment and are not placed on an multi-drug resistant TB (MDR-TB) regimen, and b) relate the treatment outcomes to culture and drug susceptibility patterns (C&DST). Design: Retrospective cohort study using routine programme data and Mycobacterium TB Culture C&DST between July 2008 and December 2009. Results: There were 202 individuals given a re-treatment regimen and included in the study. Overall treatment outcomes were: 68(34%) with treatment success, 84(42%) failed, 36(18%) died, 13(6.5%) defaulted and 1 transferred out. Treatment success for category I and II failures was low at 37%. In those with positive cultures, 81 had pan-sensitive strains with 31(38%) showing treatment success, while 61 had drug-resistance strains with 9(15%) showing treatment success. In 58 patients with negative cultures, 28(48%) showed treatment success. Conclusion: Treatment outcomes of patients who fail a first-line anti-TB treatment and who are not placed on an MDR-TB regimen are unacceptably poor. The worst outcomes are seen among category II failures and those with negative cultures or drug-resistance. There are important programmatic implications which need to be addressed. © 2011 Burugina Nagaraja et al.