Treatment of Drug-Resistant Tuberculosis: Current Status

AbstractDrug-resistant tuberculosis (DR-TB) has been an area of growing concern and posing threat to human health worldwide. The treatment has been defined for all types of DR-TB with or without newer anti-TB drugs. multi-DR-TB (MDR-TB) patients have now choice of two types of regimen, shorter and longer regimens. Shorter regimen for treatment of subset of MDR-TB patients who have not been previously treated with second line drugs and in whom resistance to fluoroquinolones and second-line injectable agents has been excluded is given for 9 to 11 months. A longer regimen of at least five effective anti-TB drugs (ATDs) during the intensive phase is recommended, including pyrazinamide and four core second-line ATDs. Intensive phase, including injectables, should be given for at least 8 months. The total duration of treatment is at least 20 months, which can be prolonged up to 24 months depending on the response of the patient. World Health Organization (WHO) has recently revised the grouping of ATD for use in DR-TB patients in 2018 into three groups based on individual patient data meta-analysis depending on their individual efficacy, risk of relapse, treatment failure, and death. Recently, an all oral longer regimen comprising bedaquiline, pretomanid, and linezolid (BPal regime) for 6 to 9 months for extensive-DR-TB (XDR-TB) patients and those MDR-TB patients who cannot tolerate or do not respond to conventional MDR-TB regimen. These new developments will be a step forward toward establishing universal regimen to treat all types of DR-TB. This article has summarized the current evidence from literature search to date, including prevalence of DR-TB, types of regimen used and the advancement in the regimens for effective treatment of DR-TB patients.

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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

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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.

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Person-centred care in practice: perspectives from a short course regimen for multi-drug resistant tuberculosis in Karakalpakstan, Uzbekistan

BMC Infectious Diseases ◽

10.1186/s12879-020-05407-7 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Shona Horter ◽

Beverley Stringer ◽

Nell Gray ◽

Nargiza Parpieva ◽

Khasan Safaev ◽

...

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Treatment Regimen ◽

World Health ◽

Drug Resistant ◽

Shared Decision ◽

Drug Resistant Tuberculosis ◽

Resistant Tuberculosis ◽

Multi Drug Resistant Tuberculosis ◽

Mdr Tb

Abstract Introduction Person-centred care, an internationally recognised priority, describes the involvement of people in their care and treatment decisions, and the consideration of their needs and priorities within service delivery. Clarity is required regarding how it may be implemented in practice within different contexts. The standard multi-drug resistant tuberculosis (MDR-TB) treatment regimen is lengthy, toxic and insufficiently effective. 2019 World Health Organisation guidelines include a shorter (9–11-month) regimen and recommend that people with MDR-TB be involved in the choice of treatment option. We examine the perspectives and experiences of people with MDR-TB and health-care workers (HCW) regarding person-centred care in an MDR-TB programme in Karakalpakstan, Uzbekistan, run by Médecins Sans Frontières and the Ministry of Health. Methods A qualitative study comprising 48 interviews with 24 people with MDR-TB and 20 HCW was conducted in June–July 2019. Participants were recruited purposively to include a range of treatment-taking experiences and professional positions. Interview data were analysed thematically using coding to identify emerging patterns, concepts, and categories relating to person-centred care, with Nvivo12. Results People with MDR-TB were unfamiliar with shared decision-making and felt uncomfortable taking responsibility for their treatment choice. HCW were viewed as having greater knowledge and expertise, and patients trusted HCW to act in their best interests, deferring the choice of appropriate treatment course to them. HCW had concerns about involving people in treatment choices, preferring that doctors made decisions. People with MDR-TB wanted to be involved in discussions about their treatment, and have their preference sought, and were comfortable choosing whether treatment was ambulatory or hospital-based. Participants felt it important that people with MDR-TB had knowledge and understanding about their treatment and disease, to foster their sense of preparedness and ownership for treatment. Involving people in their care was said to motivate sustained treatment-taking, and it appeared important to have evidence of treatment need and effect. Conclusions There is a preference for doctors choosing the treatment regimen, linked to shared decision-making unfamiliarity and practitioner-patient knowledge imbalance. Involving people in their care, through discussions, information, and preference-seeking could foster ownership and self-responsibility, supporting sustained engagement with treatment.

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Cost comparison of nine-month treatment regimens with 20-month standardized care for the treatment of rifampicin-resistant/multi-drug resistant tuberculosis in Nigeria

PLoS ONE ◽

10.1371/journal.pone.0241065 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0241065

Author(s):

Florence O. Bada ◽

Nick Blok ◽

Evaezi Okpokoro ◽

Saswata Dutt ◽

Christopher Akolo ◽

...

Keyword(s):

Treatment Regimen ◽

Treatment Success ◽

Cost Savings ◽

Drug Resistant ◽

Second Line ◽

Success Rates ◽

Drug Resistant Tuberculosis ◽

Treatment Regimens ◽

Resistant Tuberculosis ◽

Mdr Tb

Background Globally, drug resistant tuberculosis (DR-TB) continues to be a public health threat. Nigeria, which accounts for a significant proportion of the global burden of rifampicin/multi-drug resistant-TB (RR/MDR-TB) had a funding gap of $168 million dollars for TB treatment in 2018. Since 2010, Nigeria has utilized five different models of care for RR/MDR-TB (Models A-E); Models A, B and C based on a standardized WHO-approved treatment regimen of 20–24 months, were phased out between 2015 and 2019 and replaced by Models D and E. Model D is a fully ambulatory model of 9–12 months during which a shorter treatment regimen including a second-line injectable agent is utilized. Model E is identical to Model D but has patients hospitalized for the first four months of care while Model F which is to be introduced in 2020, is a fully ambulatory, oral bedaquiline-containing shorter treatment regimen of 9–12 months. Treatment models for RR/MDR-TB of 20–24 months duration have had treatment success rates of 52–66% while shorter treatment regimens have reported success rates of 85% and above. In addition, replacing the second-line injectable agent in a shorter treatment regimen with bedaquiline has been found to further improve treatment success in patients with fluoroquinolone-susceptible RR/MDR-TB. Reliable cost data for RR/MDR-TB care are limited, specifically costs of models that utilize shorter treatment regimens and which are vital to guide Nigeria through the provision of RR/MDR-TB care at scale. We therefore conducted a cost analysis of shorter treatment regimens in use and to be used in Nigeria (Models D, E and F) and compared them to three models of longer duration utilized previously in Nigeria (Models A, B and C) to identify any changes in cost from transitioning from Models A-C to Models D-F and opportunities for cost savings. Methods We obtained costs for TB diagnostic and monitoring tests, in-patient and out-patient care from a previous study, inflated these costs to 2019 NGN and then converted to 2020 USD. We obtained other costs from the average of six health facilities and drug costs from the global drug facility. We modeled treatment on strict adherence to two Nigerian National guidelines for programmatic and clinical management of drug-resistant tuberculosis. Results We estimated that the total costs of care from the health sector perspective for Models D, E and F were $4,334, $7,705 and $3,420 respectively. This is significantly lower than the costs of Models A, B and C which were $14,781, $12, 113, $7,572 respectively. Conclusion Replacing Models A–C with Models D and E reduced the costs of RR/MDR-TB care in Nigeria by approximately $5,470 (48%) per patient treated and transitioning from Models D and E to Model F would result in further cost savings of $914 to $4,285 (21 to 56%) for every patient placed on Model F. If the improved outcomes of patients managed using bedaquiline-containing shorter treatment regimens in other countries can be attained in Nigeria, Model F would be the recommended model for the scale up of RR/MDR-TB care in Nigeria.

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Second Line Drugs Resistant Mycobacterium Tuberculosis in Multi-Drug Resistant Tuberculosis Patients

Journal of Institute of Science and Technology ◽

10.3126/jist.v22i2.19609 ◽

2018 ◽

Vol 22 (2) ◽

pp. 168-174

Author(s):

Pranita Tuladhar ◽

Dhruba Kumar Khadka ◽

Megha Raj Banjara ◽

Reshma Tuladhar

Keyword(s):

Drug Susceptibility ◽

Resistance Pattern ◽

Drug Resistant ◽

Second Line ◽

Drug Resistant Tuberculosis ◽

Resistant Tuberculosis ◽

Multi Drug Resistant Tuberculosis ◽

Mdr Tb ◽

Culture Positive ◽

Line Drug

With an increase in Multi-drug resistant tuberculosis (MDR-TB), there is a need of second line drug susceptibility test that helps in early diagnosis and minimize the risk of other powerful drug resistant Mycobacterium tuberculosis. The aim of this study was to determine second line drugs (ofloxacin, kanamycin, capreomycin) resistance pattern in MDR-TB isolates and to determine the prevalence of pre-Extensively drug resistant tuberculosis (pre-XDR-TB) and XDR-TB in MDR-TB patients. The study was conducted from February to September 2015 at National Tuberculosis Centre, Thimi, Bhaktapur. MDR-TB (resistant to isoniazid and rifampicin) patients’ sputum samples were processed by Modified Petroff’s method. Out of 92 samples, 57 were found culture positive. Following the species identification of culture positive MDR-TB isolates, second line drug susceptibility test was performed by conventional proportion method. Of 57 MDR-TB isolates, 22 (38.59%) showed resistance to ofloxacin (Ofx), 9 (15.79%) to capreomycin (Cm) and 9 (15.79%) to kanamycin (Km). One XDR-TB (1.8%) resistant to all drugs was detected. Of the remaining, 21(36.8%) were resistant to ofloxacin only and 8(15.4%) were resistant to two drugs i.e.29 (50.9%) were pre-XDR-TB. The prevalence of pre-XDR-TB and XDR-TB was found to be 50.88% and 1.75% respectively. The resistance pattern of second line anti-tuberculosis drugs showed higher ofloxacin resistance in MDR-TB patients. In a nutshell, MDR-TB cases need urgent and timely susceptibility report for second line anti-tuberculosis drugs to help the clinicians start proper drug combinations to treat MDR-TB patients. Journal of Institute of Science and Technology Volume 22, Issue 2, January 2018, page: 168-174

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Drug resistance profile among multi-drug resistant tuberculosis patients at diagnosis and correlation with history of anti-tubercular treatment in a tertiary care center

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20195251 ◽

2019 ◽

Vol 6 (6) ◽

pp. 1918

Author(s):

Rahul Kumar ◽

Rajiv Garg ◽

Silpa Kshetrimayum ◽

Amita Jain

Keyword(s):

Drug Resistance ◽

Drug Sensitivity ◽

Drug Resistant ◽

Second Line ◽

Drug Resistant Tuberculosis ◽

Resistant Tuberculosis ◽

Extensively Drug Resistant ◽

Primary Drug Resistance ◽

Mdr Tb ◽

History Of

Background: Drug Resistant Tuberculosis (DR-TB) is a major threat to the realization of the goal of a TB free world in the near future. It is important to study the reasons for the increasing number of such cases so that effective action can be taken to control this growing epidemic.Methods: Sputum from 36 patients diagnosed with acquired pulmonary Multidrug Resistant Tuberculosis (MDR-TB) were subjected to first- and second-line Drug Sensitivity Testing (DST) after liquid culture in mycobacterium growth Indicator Tube (MGIT). Primary MDR-TB cases were excluded. The relation of the drug sensitivity profile with the history of prior treatment taken was statistically analysed.Results: Majority of the patients had received appropriate treatment, and most had adhered to prescribed treatment. Among the 36 patients, 24(66.7%) were found to be Pre-Extensively Drug Resistant (Pre-XDR-TB) and 4(11.1%) were extensively drug resistant XDR-TB cases. Inappropriate prescription of fluoroquinolone (FQ) was found to be most common. Prior intake of any drug was not found to significantly affect subsequent resistance to that drug.Conclusions: Fluoroquinolone resistance is quite common in patients with DR-TB (66.7%). This study did not find the prior use of FQ or any other drug to significantly affect subsequent resistance to the drug. Primary drug resistance is thus a major concern. 11.1% patients were found to be XDR-TB cases. Hence DST for first- and second-line drugs should be done at the time of diagnosis to avoid failure of treatment with a predesigned regimen.

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Adverse events among patients of multi drug resistant tuberculosis receiving second line anti TB treatment

International Journal of Scientific Reports ◽

10.18203/issn.2454-2156.intjscirep20150955 ◽

2015 ◽

Vol 1 (6) ◽

pp. 253 ◽

Cited By ~ 1

Author(s):

Kishor B. Rathod ◽

Mangala S. Borkar ◽

Avinash R. Lamb ◽

Sanjay L. Suryavanshi ◽

Gajanan A. Surwade ◽

...

Keyword(s):

Adverse Events ◽

Adverse Drug Reactions ◽

High Protein Diet ◽

Drug Resistant ◽

Second Line ◽

Drug Reactions ◽

Drug Resistant Tuberculosis ◽

Resistant Tuberculosis ◽

Poor Treatment ◽

Mdr Tb

Background: As per WHO’s “Global Tuberculosis Report, 2012”, India accounts for an estimated 64000 patients out of 310000 cases of drug resistant TB estimated to have occurred amongst the notified cases of TB across the globe in a year. MDR-TB is a man-made phenomenon– poor treatment; poor drugs, poor adherence lead to the development of MDR-TB. Treatment of MDR-TB is difficult, much costlier, challenging and needs experience and skills. Reserve drugs are frequently associated with high rates of unacceptable adverse drug reactions, needing change of regimen. Therefore, it is imperative to monitor and treat adverse drug reactions. Methods: The present prospective observational study was carried out at Drug Resistant Tuberculosis Centre at Govt. Medical College, Aurangabad, Maharashtra, to monitor patients for early detection of adverse events after starting treatment till the patients were admitted and later followed up personally or telephonically at regular intervals.Results: We observed adverse drug reactions among 90/265 (33.96 %) patients of whom 90/265 (33.96 %) had gastro intestinal ADRs, followed by ototoxicity 15/265 (5.66%), psychiatric manifestations 14/265 (5.28%), injection site pain swelling 13/265 (4.90%), arthralgia 11/265 (4.15%), dermatological ADRs 7/265 (2.64%), peripheral neuropathy 5/265 (1.88%), renal dysfunction 3/265 (1.13%), change of therapy was only required in 13 psychiatric and 12 ototoxic ADRs.Conclusions: ADRs are more common in MDR TB patients on second line anti tubercular treatment. Good counseling, spacing drugs, high protein diet helps patients to tolerate therapy better and default rate to drop.

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Person-centred care in practice: Perspectives from a short-course regimen for multi-drug resistant tuberculosis in Karakalpakstan, Uzbekistan

10.21203/rs.3.rs-24638/v2 ◽

2020 ◽

Author(s):

Shona Horter ◽

Beverley Stringer ◽

Nell Gray ◽

Nargiza Parpieva ◽

Khasan Safaev ◽

...

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Treatment Regimen ◽

World Health ◽

Drug Resistant ◽

Shared Decision ◽

Drug Resistant Tuberculosis ◽

Resistant Tuberculosis ◽

Multi Drug Resistant Tuberculosis ◽

Mdr Tb

Abstract Introduction: Person-centred care, an internationally recognised priority, describes the involvement of people in their care and treatment decisions, and the consideration of their needs and priorities within service delivery. Clarity is required regarding how it may be implemented in practice within different contexts. The standard multi-drug resistant tuberculosis (MDR-TB) treatment regimen is lengthy, toxic and insufficiently effective. 2019 World Health Organisation guidelines include a shorter (9-11-month) regimen and recommend that people with MDR-TB be involved in the choice of treatment option. We examine the perspectives and experiences of people with MDR-TB and health-care workers (HCW) regarding person-centred care in an MDR-TB programme in Karakalpakstan, Uzbekistan, run by Médecins Sans Frontières and the Ministry of Health.Methods: A qualitative study comprising 48 interviews with 24 people with MDR-TB and 20 HCW was conducted in June-July 2019. Participants were recruited purposively to include a range of treatment-taking experiences and professional positions. Interview data were analysed thematically using coding to identify emerging patterns, concepts, and categories relating to person-centred care, with Nvivo12.Results: People with MDR-TB were unfamiliar with shared decision-making and felt uncomfortable taking responsibility for their treatment choice. HCW were viewed as having greater knowledge and expertise, and patients trusted HCW to act in their best interests, deferring the choice of appropriate treatment course to them. HCW had concerns about involving people in treatment choices, preferring that doctors made decisions. People with MDR-TB wanted to be involved in discussions about their treatment, and have their preference sought, and were comfortable choosing whether treatment was ambulatory or hospital-based. Participants felt it important that people with MDR-TB had knowledge and understanding about their treatment and disease, to foster their sense of preparedness and ownership for treatment. Involving people in their care was said to motivate sustained treatment-taking, which some felt directly observed treatment (DOT) could undermine. Conclusions: There is a preference for doctors choosing the treatment regimen, linked to shared decision-making unfamiliarity and practitioner-patient knowledge imbalance. Involving people in their care, through discussions, information, and preference-seeking could foster ownership and self-responsibility, supporting sustained engagement with treatment, which DOT may contradict.

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Multidrug Resistant Tuberculosis in Children in Port Harcourt – A Worrisome Trend

International Journal of TROPICAL DISEASE & Health ◽

10.9734/ijtdh/2019/v37i330166 ◽

2019 ◽

pp. 1-8

Author(s):

Lucy Eberechukwu Yaguo Ide ◽

Nsirimobu Ichendu Paul ◽

Rosemary Ogochukwu Ugwu

Keyword(s):

Multidrug Resistant ◽

Drug Resistant ◽

Second Line ◽

Female Ratio ◽

Intensive Phase ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Port Harcourt ◽

Mdr Tb ◽

Paediatric Tuberculosis

Background: Drug-resistant tuberculosis and multidrug-resistant tuberculosis (MDR-TB) in particular represent a major threat to the fight against tuberculosis globally. MDR-TB presents with similar features and is transmitted in the same way as drug sensitive TB but its progression is rapid and its treatment, associated drug toxicity and monitoring constitute a heavy burden to the patients and the health system. MDR-TB affect people of all age groups but very little is known about the magnitude of this problem in children. Aims/Objectives: To determine the prevalence of multidrug resistant tuberculosis among children in Port Harcourt. Materials and Methods: Information on Paediatric tuberculosis was retrieved from the patients’ case notes, TB registers at the directly observed treatment short course (DOTs) clinic and the Multidrug resistant tuberculosis (MDR-TB) treatment center of the University of Port Harcourt Teaching Hospital from January 2018 to June 2019. Obtained data was analysed and presented in prose and tables. Results: There was a total of 1,860 patients records of which 37 were Paediatrics cases giving a prevalence of Paediatric tuberculosis cases of 2.0% Out of these 37cases, four were multidrug resistant tuberculosis cases giving a prevalence of MDR-TB cases of 10.8%. There were three males and one female giving a male female ratio of 3: 1. and their ages ranged from 3months to 24months. All belonged to social class 5. Common presentation was chronic cough, prolonged fever, weight loss and lymph node swellings. Three (75%) had no prior treatment for tuberculosis while one (25%) completed 6months of anti TB drugs. All had BCG immunization within one week of delivery. One (25%) child had extra-pulmonary TB while 3(75%) children had pulmonary tuberculosis. Xpert MTB/RIF assay for all (100%) showed MTB detected, RIF resistant detected. Three (75%) of the mothers had MDRTB and the medications for their children was based on the drug sensitivity testing (DST) of their mothers. One (25%) of the children and his mother were HIV positive and the mother had died while still on the intensive phase of second line antiTB drugs. Three (75%) had completed the intensive phase of the conventional therapy with second line antiTB drugs and are closely followed up weekly on the continuation phase while one child is still on admission. Conclusions: The prevalence of MDR-TB in children in PH is high. All childhood TB (whether drug susceptible or drug resistant) is usually traced to an adult, thus effectively diagnosing and treating all adults as well as a high index of suspicion in presumptive cases is required to curb MDR-TB. Recommendations: We recommend strict use of the DOTs strategy in TB management to ensure drug adherence. Also, proper contact tracing, investigation and treatment of children of infected parents to reduce cases of MDR-TB is advocated.

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Treatment outcome of multi-drug resistant tuberculosis patients on second line anti-tuberculosis dugs at tertiary care hospital at Himachal Pradesh, India

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20203387 ◽

2020 ◽

Vol 7 (8) ◽

pp. 3119

Author(s):

Anita Kumari ◽

Parveen K. Sharma ◽

Rekha Bansal

Keyword(s):

Tertiary Care ◽

Successful Outcome ◽

Care Hospital ◽

Drug Resistant ◽

Second Line ◽

Drug Resistant Tuberculosis ◽

Tuberculosis Patients ◽

Resistant Tuberculosis ◽

Multi Drug Resistant Tuberculosis ◽

Mdr Tb

Background: MDR-TB treatment defaulter are potentially harmful to community as these can relapse and spread infection, developed resistance to second line anti tubercular drugs and may result in to extensive drug resistant tuberculosis (XDR-TB) and major challenges for successful outcome. Objective was to study treatment outcome of multi-drug resistant tuberculosis patients on second line anti-tuberculosis drugs at tertiary care hospital at Himachal Pradesh.Methods: It was prospective observational study carried out after approval from institutional ethics committee. A total 104 MDR/RR-TB case enrolled for study from November 2012 to October 2013. Data were collected in predesigned proforma and entered in to Microsoft excel worksheet 2007 and analyzed with the help of SPSS software version 17. Chi-square test was applied to find out the association between independent variable and outcome of MDR-TB and p<0.05 was considered statistically significant.Results: Among all 104 patients initiated on treatment 73.07% patients were alive, completed intensive phase and switch to continuation phase of treatment, 14.42% patients were died, 5.76% defaulted, 0.96% patient was transferred out and 5.76% patients were turned out XDR-TB and switched to regimen of XDR-TB treatment.Conclusions: Treatment and control of MDR-TB require sound infrastructure and well equipped laboratory facilities to provide quality and prompt diagnosis. Lack of knowledge, awareness, long duration of treatment and defaulters are major challenges for successful outcome.

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