A study on outcome of standardized treatment in multi-drug resistance tuberculosis patients

Authors

  • Neeta P. N. Department of Community Medicine, VIMS, Ballari, Karnataka
  • Prashanth N. Department of Community Medicine, VIMS, Ballari, Karnataka
  • G. Ramaprasad Department of Community Medicine, VIMS, Ballari, Karnataka
  • T. Gangadhar Goud Department of Community Medicine, VIMS, Ballari, Karnataka
  • Sameena A.R. B. Department of Community Medicine, VIMS, Ballari, Karnataka

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20151573

Keywords:

Multi-drug resistance tuberculosis, Line Probe Assay method, RNTCP

Abstract

Background: Programmatic management of Multi-drug resistance Tuberculosis (MDR-TB) using a standardized treatment regimen (STR) is being implemented under the Revised National Tuberculosis Control Programme (RNTCP) in India. Our study was undertaken to analyze the outcomes of MDR-TB patients treated at the Drug resistance centre (also known as Dots Plus Centre, DR-TB) Bellary, with the RNTCP recommended 24-27months STR, under programmatic conditions.

Methods:Patients confirmed to have MDR-TB by Line Probe Assay (LPA) method, from Intermediate reference laboratory (IRL) Bangalore, were treated with the RNTCP’s STR in a prospective field trial on a predominantly ambulatory basis. Forty three patients were enrolled to the trial from December 2012 to April 2013.

Results: At the end of treatment, 19 (44.2%) were cured, 12 defaulted, 9 died, 1 failure and 2 were under XDR TB evaluation. Thirty two (74.2%) patients reported adverse drug reactions (ADRs) which required dose reduction or termination of the offending drug. No patient had XDR-TB initially, but 3 cases emerged for XDR-TB evaluation during treatment. Before start of treatment mean body mass index (BMI) was 17.67±3.627 kg/mt2. 34 patients had far advanced lesions on chest x-ray. Outcome was better in those patients, whose tubercular bacilli resistant both to rifampicin and isoniazid and who had good adherence in the past tubercular treatment.

Conclusions:Outcomes of this small group of MDR-TB patients treated with the RNTCP’s STR is encouraging in this setting. Close attention needs to be paid to ensure adherence, and to the timely recognition and treatment of ADRs.

 

References

Central TB Division (CTD), Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India. DOTS-plus guidelines. New Delhi: CTD; May 2012.

Kapadia VK, Tripathi SB. Analysis of 63 patients of MDR TB on DOTS plus regimen: An LG hospital, TB Unit, Ahmedabad experience. GMJ. 2013;68(2):52-7.

WHO. Global Tuberculosis Control: Report, 2011. Last accessed on 2012 Apr 21. Available from: http://www.whqlibdoc.who.int/publications/2011/9789241564380_eng.pdf.

Pouline J, Vijaya BRD, Nalini SM, Jemima SF, Rajeswari R, Balambal R, et al. Outcome of standardized treatment for with MDR-TB from Tamil Nadu, India. Indian J Med Res. 2011;133:529-34.

Jonna IDH, Anna W, Daniel E, Feleke M, Assefa G, Aschalew G, et al. Nitric oxide production in the exhaled air of patients with pulmonary tuberculosis in relation to HIV co-infection. BMC Infectious Diseases. 2008;8:146.

Singla R, Sarin R, Khalid UK, Mathuria K, Singla N, Jaiswal A, et al. Seven-year DOTS-Plus pilot experience in India: Results, constraints and issues. Int J Tuberc Lung Dis. 2009;13:976-81.

Van DA, Salim MA, Das AP, Bastian I, Portaels F. Results of a standardised regimen for multidrug-resistant tuberculosis in Bangladesh. Int J Tuberc Lung Dis. 2004;8:560-7.

Shin SS, Pasechnikov AD, Gelmanova IY, Peremitin GG, Strelis AK, Mishustin S, et al. Treatment outcomes in an integrated civilian and prison MDR-TB treatment program in Russia. Int J Tuberc Lung Dis. 2006;10:402-8.

Kalpesh J, Mira D, Rajesh S, and Ram Kumar D. Treatment outcome of standardized regimen in patients with multidrug resistant tuberculosis. J Pharmacol Pharmacother. 2014;5(2):145-9.

Chiang CY, Enarson DA, Yu MC, Bai KJ, Huang RM, Hsu CJ, et al. Outcome of pulmonary multidrug-resistant tuberculosis: A 6-yr follow-up study. Eur Respir J. 2006;28:980-5.

Park SK, Lee WC, Lee DH, Mitnick CD, Han L, Seung KJ. Self-administered, standardized regimens for multidrug-resistant tuberculosis in South Korea. Int J Tuberc Lung Dis. 2004;8:361-8.

Liu CH, Li L, Chen Z, Wang Q, Hu YL, Zhu B, et al. Characteristics and treatment outcomes of patients with MDR and XDR tuberculosis in a TB Referral Hospital in Beijing: A 13-year experience. PLoS One. 2011;6:e19399.

Prasad R, Verma SK, Sahai S, Kumar S, Jain A. Efficacy and safety of kanamycin, ethionamide, PAS, and cycloserine in multidrug-resistant pulmonary tuberculosis patients. Indian J Chest Dis Allied Sci. 2006;48:183-6.

Yew WW, Chan CK, Chau CH, Tam CM, Leung CC, Wong PC, et al. Outcomes of patients with multidrug- resistant pulmonary tuberculosis treated with ofloxacin/levofloxacin- containing regimens. Chest. 2000;117:744-51.

Tahaoglu K, Törün T, Sevim T, Atac G, Kir A, Karasulu L, et al. The treatment of multi-drug resistant tuberculosis in Turkey. N Engl J Med. 2001;345:170-4.

Mitnick C, Bayona J, Palacios E, Shin S, Furin J, Felix Alcántara F, et al. Community-based therapy for multi-drug resistant tuberculosis in Lima, Peru. N Engl J Med. 2003;348:119-28.

Malla P, Kanitz EE, Akhtar M, Falzon D, Feldmann K, Gunneberg C, et al. Ambulatory-based standardized therapy for multidrug resistant tuberculosis: experience from Nepal, 2005-2006. PLoS One. 2009;4:08313.

Torun T, Gungor G, Ozmen I, Maden E, Bicakci B, Atac G, et al. Side effects associated with the treatment of multidrug-resistant tuberculosis. Int J Tuberc Lung Dis. 2005;9(12):1373-7.

Thomas A, Ramchandra R, Rehaman F, Jaggarajamma K, Santha T, Selvakumar N, et al. Management of multi-drug resistant tuberculosis in the field- Tuberculosis Research Centre experience. Indian J Tuberc. 2007:54:117-24.

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Published

2017-01-31

How to Cite

N., N. P., N., P., Ramaprasad, G., Goud, T. G., & B., S. A. (2017). A study on outcome of standardized treatment in multi-drug resistance tuberculosis patients. International Journal Of Community Medicine And Public Health, 3(1), 257–263. https://doi.org/10.18203/2394-6040.ijcmph20151573

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Original Research Articles