Study of prevalence and outcome of standardized treatment on category I pulmonary tuberculosis cases in North India: A single center experience
Outcome of standardized treatment on category I pulmonary tuberculosis
Keywords:
Category I TB patients, drug-resistant tuberculosis, multidrug-resistant-tuberculosis, standardized regimen, treatment outcomeAbstract
Background and Objective: The emergence of resistance to drugs used to treat tuberculosis (TB), and particularly multidrug-resistant TB, has become a significant public health problem globally. In spite newer modalities for diagnosis and treatment of TB, unfortunately, millions of people are still suffering and dying from the disease. The present study was aimed to study the prevalence of initial drug resistance and the treatment outcome at the end of 6 months in TB patients attending a dedicated TB outpatient department (OPD) in North India. Materials and Methods: A cross-sectional, observational study was carried out on 100 patients of newly diagnosed pulmonary TB with or without glandular involvement attending TB OPD of a tertiary care hospital over a period of 6 months. Results: Culture positivity was encountered in 82% of the cases, while 14% were smear positive though culture negative. Out of all culture positive patients, 56.1% were susceptible to all antitubercular drugs, while 43.9% were resistant to one or other antitubercular drugs (isoniazid, rifampicin, streptomycin or ethambutol). Of the 46 drug-susceptible cases, 93.48% got cured, while 2.2% defaulted and 2.2% had treatment failure. About 86.1% of the 36 initial drug resistant were cured with 2RHZE/4RH, while 5.6% (n = 2) defaulted treatment and 8.3% were treatment failures. Conclusion: Treatment outcomes of this small group of drug-resistant pulmonary TB patients treated with the standardized regimen was encouraging in this setting. Close attention needs to be paid to ensure early identification of drug-resistant cases; good laboratory methodology and quality control measures; regular supply of quality antitubercular drugs; adherence to the prescribed regimen; effective patient education and counseling; and to the timely recognition and treatment of adverse drug reactions for better treatment outcome.
References
Tuberculosis WHO Global Tuberculosis Report; 2014. Available from: . [Last accessed on 2015 Mar 18].
Revised National Tuberculosis Control Programme. Technical and Operational Guidelines for Tuberculosis Control. Available from: . [Last accessed on 2015 Mar 21].
Maurya AK, Singh AK, Kumar M, Umrao J, Kant S, Nag VL, et al. Changing patterns and trends of multidrug-resistant tuberculosis at referral centre in Northern India: A 4-year experience. Indian J Med Microbiol 2013;31:40-6.
Revised National Tuberculosis Control Programme. Guidelines on Programmatic Management of Drug Resistant TB (PMDT) in India. Available from: . [Last accessed on 2015 Mar 23].
Mahadev B, Kumar P, Agarwal SP, Chauhan LS, Srikantaramu N. Surveillance of drug resistance to anti-tuberculosis drugs in districts of Hoogli in West Bengal and Mayurbhanj in Orissa. Indian J Tuberc 2005;52:5-10.
Paramasivan CN, Venkataraman P, Chandrasekaran V, Bhat S, Narayanan PR. Surveillance of drug resistance in tuberculosis in two districts of South India. Int J Tuberc Lung Dis 2002;6:479-84.
Tuberculosis Research Centre, Indian Council of Medical Research, Chennai, India. Low rate of emergence of drug resistance in sputum positive patients treated with short course chemotherapy. Int J Tuberc Lung Dis 2001;5:40-5.
Multidrug Resistant Tuberculosis (MDR-TB). Available from: http://www.who.int/tb/challenges/mdr/en/. [Last accessed on 2015 Mar 18].
Information on Tuberculosis. World Health Organization. Available from: . [Last accessed on 2015 Mar 18].
Information about Tuberculosis. Available from: http://www.tbfacts.org/tb-statistics-india.html. [Last accessed on 2015 Mar 23].
Information about Tuberculosis. Available from: http://www.tbfacts.org/tb-india.html. [Last accessed on 2015 Mar 23].
Revised National Tuberculosis Control Programme. DOTS-Plus Guidelines. Available from: . [Last accessed on 2015 Mar 27].
Multidrug-Resistant Tuberculosis. Available from: http://www.who.int/tb/challenges/mdr/mdr_tb_factsheet.pdf. [Last accessed on 2015 Mar 23].
East African/British Medical Research Council. Controlled clinical trial of five short course (4 month) chemotherapy regimens in pulmonary tuberculosis. Am Rev Respir Dis 1981;123:165.
Jain NK, Chopra KK, Prasad G. Initial and acquired isoniazid and rifampicin resistance to M. tuberculosis and its implication for treatment. Indian J Tuberc 1992;39:121.
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.
Malla P, Kanitz EE, Akhtar M, Falzon D, Feldmann K, Gunneberg C, et al. Ambulatory-based standardized therapy for multi-drug resistant tuberculosis: Experience from Nepal, 2005-2006. PLoS One 2009;4:e8313.
Nathanson E, Gupta R, Huamani P, Leimane V, Pasechnikov AD, Tupasi TE, et al. Adverse events in the treatment of multidrug-resistant tuberculosis: Results from the DOTS-Plus initiative. Int J Tuberc Lung Dis 2004;8:1382-4.
Global Tuberculosis Report 2013. World Health Organization. Available from: . [Last accessed on 2015 Mar 23].
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