Treatment Outcome of Multidrug Resistant Tuberculosis Patients in Modified DOTS-PLUS: A New Strategy - Two Years Experience

Abstract

Background: Multidrug-resistant tuberculosis (MDR-TB) is a worldwide problem and growing hazard to human health. Its treatment is notoriously difficult and challenging. Therefore, the study has been conducted to know the treatment outcome with second-line drugs in patients of MDR-TB in modified DOTS-PLUS strategy. Materials and Methods: This was a prospective cohort study analyzing 98 consecutive patients with MDRTB attending the Department of Pulmonary Medicine, CSMMU, Lucknow, between June 2009 and February 2010 with follow-up till August 2011. All the patients were given medications free of cost as per the DOTSPLUS Protocol of the Revised National Tuberculosis Control Programme (RNTCP), which included monthly follow-up, adherence to check-up, radiological and bacteriological assessment (sputum smear advised monthly till conversion then quarterly; culture for MTB at 0, 4, 6, 12, 18 and 24 months), intense health education and monitoring of adverse effects. Patient outcome was considered as 'cure' when at least two of the last three cultures were negative, and as 'failure' when the same were positive. Results: All the patients had resistance to at least Isoniazid and Rifampicin, and were seronegative for HIV. Default rate at the end of 6 months, 12 months and 18 months were found to be 2.1%, 4.1% and 5.1%, respectively. Ten (10.2%) patients expired by the completion of 18 months of treatment. Mean smear and culture conversion times were 3.4 +/- 2.1 months (range 1-11) and 4.6 +/- 2.5 months (range 4-12), respectively. Sputum smear and culture conversion at the end of 18 months were 77/83 (92.8%) and 74/83 (89.2%), respectively. Only nine patients remained culture positive, of which six were proved to be MDR-TB. Significant side-effects were experienced in only 15.3% of the patients. Conclusions: Culture conversion rate at the end of 18 months was 89.2%. Only 5.1% patients defaulted and 10.2% patients expired by the end of 18 months.