Abstract #1036 Hypothyroidism Induced by Multi Drug Resistant Tuberculosis (MDR-TB) Treatment

Background: In Uganda, 12% of previously treated TB cases and 1.6% of new cases have MDR-TB and require specialized treatment and care. Adherence is crucial for improving MDR-TB treatment outcomes. There is paucity of information on the extent to which these patients adhere to treatment and what the drivers of non-adherence are. Methods: We conducted a cohort study using retrospectively collected routine program data for patients treated for MDR- TB between January 2012 – May 2016 at Mulago Hospital. We extracted anonymized data on non-adherence (missing 10% or more of DOT), socio-economic, demographic, and treatment characteristics of the patients. All participants were sen- sitive to MDR-TB drugs after second line Drug Susceptible Testing (DST) at entry into the study. Factors associated with non-adherence to MDR-TB treatment were determined using generalized linear models for the binomial family with log link and robust standard errors. We considered a p- value less than 0.05 as statistically significant. Results: The records of 227 MDR- TB patients met the inclusion criteria, 39.4% of whom were female, 32.6% aged be- tween 25 – 34 years, and 54.6% living with HIV/AIDS. About 11.9% of the patients were non-adherent. The main driver for non-adherence was history of previous DR-TB treatment; previously treated DR-TB patients were 3.46 (Adjusted prev- alence ratio: 3.46, 95 % CI: 1.68 - 7.14) times more likely to be non-adherent. Conclusion: One in 10 MDR-TB patients treated at Mulago hospital is non-adherent to treatment. History of previous DR- TB treatment was significantly associated with non-adherence in this study. MDR-TB program should strengthen adherence counselling, strengthen DST surveillance, and close monitoring for previously treated DR-TB patients. Keywords: Non-adherence; multi-drug resistant tuberculosis; treatment.

Download Full-text

Adverse Drug Reactions in Patients put on Multi Drug Resistant Tuberculosis (MDR-TB) Treatment in Seven Districts of Central Gujarat

Journal of Young Pharmacists ◽

10.5530/jyp.2015.4s.3 ◽

2015 ◽

Vol 7 (4s) ◽

pp. 425-431 ◽

Cited By ~ 2

Author(s):

Sangita Vashrambhai Patel ◽

Nimavat Kapil Bhikhubhai ◽

Alpesh Bhimabhai patel ◽

Kalpita Samrat Shringarpure ◽

Kedar Gautambhai Mehta ◽

...

Keyword(s):

Adverse Drug Reactions ◽

Drug Resistant ◽

Drug Reactions ◽

Drug Resistant Tuberculosis ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Multi Drug Resistant Tuberculosis ◽

Mdr Tb

Download Full-text

Prevalence and risk factors of multi-drug resistant tuberculosis in Dalian, China

Journal of International Medical Research ◽

10.1177/0300060516687429 ◽

2017 ◽

Vol 45 (6) ◽

pp. 1779-1786 ◽

Cited By ~ 9

Author(s):

Xin-Tong Lv ◽

Xi-Wei Lu ◽

Xiao-Yan Shi ◽

Ling Zhou

Keyword(s):

Risk Factors ◽

Population History ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Multi Drug Resistant Tuberculosis ◽

Mdr Tb ◽

Previously Treated Patients ◽

Previously Treated

Objectives To investigate the prevalence and risk factors associated with multi-drug resistant tuberculosis (MDR–TB) in Dalian, China. Methods This was a retrospective review of data from patients attending a TB clinic in Dalian, China between 2012 and 2015. Demographic and drug susceptibility data were retrieved from TB treatment cards. Univariate logistic analysis was used to assess the association between risk factors and MDR–TB. Results Among the 3552 patients who were smear positive for Mycobacterium tuberculosis (MTB), 2918 (82.2%) had positive MTB cultures and 1106 (31.1%) had isolates that showed resistance to at least one drug. The overall prevalence of MDR–TB was 10.1% (359/3552; 131/2261 [5.8%] newly diagnosed and 228/1291 [17.7%] previously treated patients). Importantly, 75 extensively drug-resistant TB isolates were detected from 25 newly treated and 50 previously treated patients. In total, 215 (6.1%) patients were infected with a poly-resistant strain of MTB. Previously treated patients and older patients were more likely to develop MDR–TB. Conclusions The study showed a high prevalence of MDR–TB among the study population. History of previous TB treatment and older age were associated with MDR–TB.

Download Full-text

S2 Multi-drug Resistant Tuberculosis (MDR-TB) treatment in the UK: a survey of injectable use and toxicity in practice

Thorax ◽

10.1136/thx.2010.150912.2 ◽

2010 ◽

Vol 65 (Suppl 4) ◽

pp. A4-A5

Author(s):

A. Sturdy ◽

A. Goodman ◽

R. J. Jose ◽

A. Loyse ◽

M. O'Donoghue ◽

...

Keyword(s):

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Multi Drug Resistant Tuberculosis ◽

Mdr Tb ◽

The Uk

Download Full-text

Predicting the Outcomes of New Short-Course Regimens for Multi-Drug Resistant Tuberculosis Using Intrahost and Pharmacokinetic-Pharmacodynamic Modelling

10.1101/369991 ◽

2018 ◽

Author(s):

Tan N Doan ◽

Pengxing Cao ◽

Theophilus I Emeto ◽

James M McCaw ◽

Emma S McBryde

Keyword(s):

Treatment Duration ◽

Treatment Success ◽

Empirical Evaluation ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Multi Drug Resistant Tuberculosis ◽

Short Course ◽

Mdr Tb

ABSTRACTShort-course regimens for multi-drug resistant tuberculosis (MDR-TB) are urgently needed. Limited data suggest that the new drug, bedaquiline (BDQ), may have the potential to shorten MDR-TB treatment to less than six months when used in conjunction with standard anti-TB drugs. However, the feasibility of BDQ in shortening MDR-TB treatment duration remains to be established. Mathematical modelling provides a platform to investigate different treatment regimens and predict their efficacy. We developed a mathematical model to capture the immune response to TB inside a human host environment. This model was then combined with a pharmacokinetic-pharmacodynamic model to simulate various short-course BDQ-containing regimens. Our modelling suggests that BDQ could reduce MDR-TB treatment duration to just 18 weeks (four months) while still maintaining a very high treatment success rate (100% for daily BDQ for two weeks, or 95% for daily BDQ for one week during the intensive phase). The estimated time to bacterial clearance of these regimens ranges from 27 to 33 days. Our findings provide the justification for empirical evaluation of short-course BDQ-containing regimens. If short-course BDQ-containing regimens are found to improve outcomes then we anticipate clear cost-savings and a subsequent improvement in the efficiency of national TB programs.

Download Full-text

Prevalence and factors associated with non-adherence to multi-drug resistant tuberculosis (MDR-TB) treatment at Mulago National Referral Hospital, Kampala, Uganda

African Health Sciences ◽

10.4314/ahs.v21i1.31 ◽

2021 ◽

Vol 21 (1) ◽

pp. 238-47

Author(s):

Charles Batte ◽

Martha S Namusobya ◽

Racheal Kirabo ◽

John Mukisa ◽

Susan Adakun ◽

...

Keyword(s):

Mulago Hospital ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Factors Associated ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Multi Drug Resistant Tuberculosis ◽

Mdr Tb ◽

History Of ◽

Previously Treated

Background: In Uganda, 12% of previously treated TB cases and 1.6% of new cases have MDR-TB and require specialized treatment and care. Adherence is crucial for improving MDR-TB treatment outcomes. There is paucity of information on the extent to which these patients adhere to treatment and what the drivers of non-adherence are. Methods: We conducted a cohort study using retrospectively collected routine program data for patients treated for MDR- TB between January 2012 – May 2016 at Mulago Hospital. We extracted anonymized data on non-adherence (missing 10% or more of DOT), socio-economic, demographic, and treatment characteristics of the patients. All participants were sen- sitive to MDR-TB drugs after second line Drug Susceptible Testing (DST) at entry into the study. Factors associated with non-adherence to MDR-TB treatment were determined using generalized linear models for the binomial family with log link and robust standard errors. We considered a p- value less than 0.05 as statistically significant. Results: The records of 227 MDR- TB patients met the inclusion criteria, 39.4% of whom were female, 32.6% aged be- tween 25 – 34 years, and 54.6% living with HIV/AIDS. About 11.9% of the patients were non-adherent. The main driver for non-adherence was history of previous DR-TB treatment; previously treated DR-TB patients were 3.46 (Adjusted prev- alence ratio: 3.46, 95 % CI: 1.68 - 7.14) times more likely to be non-adherent. Conclusion: One in 10 MDR-TB patients treated at Mulago hospital is non-adherent to treatment. History of previous DR- TB treatment was significantly associated with non-adherence in this study. MDR-TB program should strengthen adherence counselling, strengthen DST surveillance, and close monitoring for previously treated DR-TB patients. Keywords: Non-adherence; multi-drug resistant tuberculosis; treatment.

Download Full-text

Barriers to Directly Observed Treatment for Multi Drug Resistant Tuberculosis Patients in Nepal - Qualitative Study

SAARC Journal of Tuberculosis Lung Diseases and HIV/AIDS ◽

10.3126/saarctb.v16i1.23239 ◽

2018 ◽

Vol 16 (1) ◽

pp. 6-18

Author(s):

R.P. Bichha ◽

K.B. Karki ◽

K.K. Jha ◽

V.S. Salhotra ◽

A.P. Weerakoon

Keyword(s):

Qualitative Study ◽

Health Workers ◽

Previous History ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Major Barrier ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Multi Drug Resistant Tuberculosis ◽

Mdr Tb

Introduction: To prevent the multi drug resistant tuberculosis (MDR-TB) is important to adhere long duration of drug regimen. There are many factors or barriers that are likely to affect adherence to the long treatment regimen. Objectives: To find out the barriers for adherence to MDR –TB treatment. Methods: The study was conducted as an institutional based qualitative study, using a convenient sampling technique. Data was collected from 50 current MDR-TB patients by trained field health workers using semi structured interviewer administered questionnaire in all regions in Nepal. Twenty five focus group discussions (FGD) were also conducted with MDR-TB patients, cured MDR-TB patients, DOTS Committee Members, health workers and close relatives of MDR-TB patients to supplement the findings. Results: Out of 50 respondents 19 were females and 31 were males. Their age varied from 22 years to 61 years. Majority of patients had a previous history of irregular TB treatment. Forty out of fifty patients (80%) were living in either rented houses or hostels (in Mid Western Region). Knowledge about TB and MDR-TB was satisfactory in majority of participants in both studies. Majority of participants were satisfied with facilities and services provided by MDR-TB clinics. There is a very little stigma associated with MDR-TB in Nepal. FGD revealed the onset of MDR-TB was attributed to causes such as smoking, alcohol abuse, poor nutrition, and contact with TB patients. Lack of money to go to health facility daily for treatment was reported as major barriers to adhere to MDR-TB treatment. Conclusion: Financial constraints were the major barrier for these patients. To sustain proper MDRTB programme, Government of Nepal and other organization should provide social support to these patients.

Download Full-text

SIDE EFFECTS ASSOCIATED WITH DRUGS USED IN TREATMENT OF MULTI DRUG RESISTANT TUBERCULOSIS AND TREATMENT RELATED FACTORS OF MULTI DRUG RESISTANT TUBERCULOSIS PATIENTS IN KATHMANDU VALLEY

SAARC Journal of Tuberculosis Lung Diseases and HIV/AIDS ◽

10.3126/saarctb.v14i1.17718 ◽

2017 ◽

Vol 14 (1) ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Chandra Prakash Bhatt ◽

B KC

Keyword(s):

Health Care ◽

Side Effects ◽

Drug Resistant ◽

Second Line ◽

Related Factors ◽

Drug Resistant Tuberculosis ◽

Resistant Tuberculosis ◽

Multi Drug Resistant Tuberculosis ◽

Mdr Tb ◽

Care Worker

Introduction: Treatment of multi drug resistant Mycobacterium tuberculosis (MDR-TB) with second line drugs is associated with adverse drug reactions and toxicity. Aim of this study were to determine side effects associated with drugs used in treatment of multi drug resistant tuberculosis and treatment related factors of MDR-TB patients.Methodology: A prospective study was carried out in National Tuberculosis Centre Bhaktapur Nepal. Questionnaires were used to collect data from patients.Results: Total 101 MDR TB patients were included among them majorities were male (52%) and mean age of the patients was 31.2 years. Majority of patients (87.1%) had previous history of tuberculosis treatment and 54.5% were in intensive phase of treatment. The side effect associated with drugs used in treatment of MDR-TB reported by patients were joint pain (21.2%), nausea (20.3%), hearing disturbances (11%), gastrointestinal disturbance (9.9%), depression (9.6%), itching (8.1%), hypothyroidism (6.4%), dizziness (6.4%), seizures (3.8%) and hepatitis (3.5%). Last month 25.74% patients missed one or more doses of drugs and 3.9% missed drug doses due to side effect of drugs. Majorities of the patients used vehicle to reach health centre (92.07%), time to reach the health center (59.4%) were less than 30 minutes but majorities of patients (57.4%) were not satisfied by the counseling of health care worker.Conclusion: The finding of this study shows that in MDR patients 12.8% were found new cases. Last month 3.9% patients were stopped the drugs due to side effects of drugs. Majority of patients (57.4%) were not satisfied by counseling of health care worker. Treatment of multi drug resistant tuberculosis with second line anti tubercular drugs is associated with side effects, health care worker counseling to MDR- TB patients with full attention is essential to encourage the patient’s moral and complete the treatment. Timely managing the side effects of medication is important in helping people to complete their treatment.SAARC J TUBER LUNG DIS HIV/AIDS, 2017; XIV(1), Page: 1-6

Download Full-text

Intensive phase treatment outcome and associated factors among patients treated for multi drug resistant tuberculosis in Ethiopia: a retrospective cohort study

BMC Infectious Diseases ◽

10.1186/s12879-019-4411-7 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Teklu Molie ◽

Zelalem Teklemariam ◽

Eveline Klinkenberg ◽

Yadeta Dessie ◽

Andargachew Kumsa ◽

...

Keyword(s):

Treatment Outcome ◽

Retrospective Cohort ◽

Multinomial Logistic Regression ◽

Drug Resistant ◽

Contributing Factors ◽

Drug Resistant Tuberculosis ◽

Intensive Phase ◽

Resistant Tuberculosis ◽

Multi Drug Resistant Tuberculosis ◽

Mdr Tb

Abstract Background Multi-drug resistant Tuberculosis (MDR-TB) is a strain of Mycobacterium tuberculosis that is resistant to at least Rifampicin and Isoniazid drugs. The treatment success rate for MDR-TB cases is lower than for drug susceptible TB. Globally only 55% of MDR-TB patients were successfully treated. Monitoring the early treatment outcome and better understanding of the specific reasons for early unfavorable and unknown treatment outcome is crucial for preventing the emergence of further drug-resistant tuberculosis. However, this information is scarce in Ethiopia. Therefore, this study aimed to determine the intensive phase treatment outcome and contributing factors among patients treated for MDR-TB in Ethiopia. Methods A 6 year retrospective cohort record review was conducted in fourteen TICs all over the country. The records of 751 MDR-TB patients were randomly selected using simple random sampling technique. Data were collected using a pre-tested and structured checklist. Multivariable multinomial logistic regression was undertaken to identify the contributing factors. Results At the end of the intensive phase, 17.3% of MDR-TB patients had an unfavorable treatment outcome, while 16.8% had an unknown outcome with the remaining having a favorable outcome. The median duration of the intensive phase was 9.0 months (IQR 8.04–10.54). Having an unfavorable intensive phase treatment outcome was found significantly more common among older age [ARRR = 1.047, 95% CI (1.024, 1.072)] and those with a history of hypokalemia [ARRR = 0.512, 95% CI (0.280, 0.939)]. Having an unknown intensive phase treatment outcome was found to be more common among those treated under the ambulatory care [ARRR = 3.2, 95% CI (1.6, 6.2)], rural dwellers [ARRR = 0.370, 95% CI (0.199, 0.66)], those without a treatment supporter [ARRR = 0.022, 95% CI (0.002, 0.231)], and those with resistance to a limited number of drugs. Conclusion We observed a higher rate of unfavorable and unknown treatment outcome in this study. To improve favorable treatment outcome more emphasis should be given to conducting all scheduled laboratory monitoring tests, assignment of treatment supporters for each patient and ensuring complete recording and reporting which could be enhanced by quarterly cohort review. Older aged and rural patients need special attention. Furthermore, the sample referral network should be strengthened.

Download Full-text

Risk factors of Multidrug Resistant Tuberculosis in central Nepal: A pilot study

Kathmandu University Medical Journal ◽

10.3126/kumj.v8i4.6238 ◽

2012 ◽

Vol 8 (4) ◽

pp. 392-397 ◽

Cited By ~ 6

Author(s):

S B Marahatta ◽

J Kaewkungwal ◽

P Ramasoota ◽

P Singhasivanon

Keyword(s):

Risk Factors ◽

Social Stigma ◽

Smoking Habit ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Resistant Tuberculosis ◽

Multi Drug Resistant Tuberculosis ◽

National Tuberculosis ◽

Mdr Tb ◽

History Of

Introduction Tuberculosis is the most widespread infectious disease in Nepal and poses a serious threat to the health and development of the country. Incidences of drug resistant tuberculosis in Nepal are increasing and this tuberculosisis a major threat to successfully controlling tuberculosis . Objective The general objective of the study was to assess the risk factors of multi-drug resistant tuberculosis among the patients attending the National Tuberculosis Centre, Bhaktpur Nepal. Methods An observational study/ case-control study with a Atotal number of 55 multi-drug resistant tuberculosis cases and 55 controls. The study was conducted among the patient attending in the National Tuberculosis Centre , Bhaktpur Nepal for six months, between May–October 2010. sImulti-drug resistant tuberculosis wasThe collected data was analysed in SPSS 11.5 version. The association between categorical variables were analysed by chi-square tests, OR and their 95% CI were measured. Results The total number of patients used for the study was 110, of which among them 55 were cases and 55 were controls . Our study revealed that there were significant associations between history of prior TB MDR-TB OR =2.799 (95 % CI 1.159 to 6.667) (p=0.020); smoking habit OR =2.350 and (95%CI 1.071 to 5.159) (p=0.032); social stigma social stigma OR 2.655 (95%CI r 1.071 to 5.159) (p=0.013); knowledge on MDR-TB OR =9.643 (95% CI 3.339 to 27.846) (p < 0.001)and knowledge on DOTS Plus OR=16.714 (95% CI is ranging from 4.656 to 60.008) (p< 0.001). However, there was no association found between alcohol drinking habits and ventilation in the room. Conclusion Our study revealed that there were significant associations between history of prior tuberculosis, smoking habit social stigma social stigma, knowledge on multi-drug resistant tuberculosis and knowledge on DOTS Plus with multi-drug resistant tuberculosis However there was no association between alcohol drinking habit and ventilation in room with multi-drug resistant tuberculosis. http://dx.doi.org/10.3126/kumj.v8i4.6238 Kathmandu Univ Med J 2010;8(4):392-7

Download Full-text