Waseem Saeed, Arshad Naseem, Jamal Ahmed


Objective: To determine the efficacy of our modified anti-tuberculosis regimen in adult patients with
multi-drug-resistant tuberculosis (MDR-TB) in the re-treatment category. Methods: Retrospective chart
review of 176 patients in re-treatment category with diagnosis of MDR-TB from 1st Jan 1993 to 31st Dec
2002 managed at the Department of Pulmonology Military Hospital Rawalpindi, Pakistan. All the patients
were given four standard first line anti-TB drugs along with any two second line drugs out of
Ofloxacin/Ciprofloxacin/Levofloxacin, Amikacin, or Clarithromycin and treatment was modified after
availability of drug susceptibility testing (DST). Results: Seventy-two percent of the patients were young
men with mean age of 32.28±8.7 yrs, 53.4% had moderately advanced while nearly 30% had extensive
disease. One-third cases had contact with a patient of pulmonary tuberculosis out of which one fifth had
contact with a MDR-TB patient. Mean duration of diagnosis of tuberculosis before therapy was
41.11±14.32 months and 70% of the cases had received at least 2 prior anti-TB regimens. They had
received a median of four anti-TB drugs in past and were infected with organisms that were resistant to a
median of 3 first line anti-TB drugs. Resistance to Ethambutol and PZA was about 18% and 11%
respectively. A median of six anti-TB drugs was used while mean duration of therapy was 22.17±2.17
months. Bacteriological cure was achieved in about 90% cases while radiological response was
documented in nearly 78%. Conclusion: Modified initial management strategy followed by DST guided
therapy has yielded excellent results and needs to be assessed in further trials for wider application.
Keywords: Modified regimen, Re-treatment TB, Multi-drug-resistant tuberculosis, MDR-TB, Tuberculosis


Frieden TR, Sterling TR, Munsiff SS, Watt CJ, Dye C.

Tuberculosis. Lancet 2003;362:887–99.

Schluger NW, Harkin TJ, Rom WN. Principles of therapy of

tuberculosis in the modern era. In: Rom WN & Garay S,

(Eds) Tuberculosis, 1st edn New York: Little Brown and

Company; 1996. p.751–61.

Narita M, Alonso P, Lauzardo M, Hollender ES, Pitchenik

AE, Ashkin D. Treatment experience of Multi Drug

Resistance Tuberculosis in Florida, 1994-1997. Chest


Espinal MA. The global situation of MDR-TB. Tuberculosis


Bastain I, Colebunders R. Treatment and prevention of

multidrug resistant tuberculosis. Drugs1999;58(4):633–41.

World Health Organization. Anti-tuberculosis drug resistance

in the world. The WHO/IUATLD Global Project on AntiTuberculosis Drug Resistance Surveillance

(WHO/TB/97.229). Geneva, World Health Organization

Document, 1997.

World Health Organization. Anti-tuberculosis drug resistance

in the world. Third global report. The WHO/IUATLD Global

Project on Anti-Tuberculosis Drug Resistance Surveillance

(WHO/CDC/TB/2004). Geneva, World Health Organization

document, 2004.

Espinal MA, Kim SJ, Suárez PG, Kam KM, Khomenko AG,

Migliori GB, et al. Standard short-course chemotherapy for

drug-resistant tuberculosis: treatment outcomes in 6

countries. JAMA 2000;283:2537–45.

Kimerling ME, Kluge H, Vezhnina N, Iacovazzi

T, Demeulenaere T, Portaels F, et al. Inadequacy of the

current WHO re-treatment regimen in a central Siberian

prison: treatment failure and MDR-TB. Int J Tuberc Lung

Dis 1999;3:451–3.

Butt T, Ahmad R N, Kazmi S Y, Rafi N. Multi-drug resistant

Tuberculosis in Northern Pakistan. J Pak Med Assoc


Almani SA, Memon NM, Qureshi AF. Drug Resistant

Tuberculosis in Sindh. J Coll Physicians Surg Pak


Iseman MD. Mycobacterial Diseases of the Lungs. In:

Hanley ME, Welsh CH (Eds). Current Diagnosis &

Treatment in Pulmonary Medicine. New York: Lange

Medical Books/MaGraw Hill; 2003. p. 399–413.

Goble M, Iseman MD, Madsen LA, Waite D, Ackerson L,

Horsburgh CR. Treatment of 171 patients with pulmonary

tuberculosis resistant to isoniazid and rifampin. N Engl J

Med 1993;328:527–32.

Chan ED, Laurel V, Strand MJ, Chan JF, Huynh MLN,

Goble M, et al. Treatment and Outcome Analysis of 205

Patients with Multidrug-resistant Tuberculosis. Am J Respir

Crit Care Med 2004;169:1103–9

Mitnick C, Bayona J, Palacios E, Shin S, Furin J, Alcantara

F, et al. Community Based Therapy for Multi Drug Resistant

Tuberculosis in Lima, Peru. N Engl J Med 2003;348:119–28.

Suo J, Yu MC, Lee CN, Chiang CY, Lin TP. Treatment of

multi-drug resistant tuberculosis in Taiwan. Chemotherapy


Park, SK, Kim CT, Song SD. Outcome of chemotherapy in

patients with pulmonary tuberculosis resistant to isoniazid

and rifampin. Int J Tuberc Lung Dis 1998;2:877–84.

Tahaoglu K, Torun T, Sevin T, Atac G, Kir A, Karasulu L,

Ozmen I, et al. The Treatment of Multidrug-Resistant

Tuberculosis in Turkey. N Engl J Med 2001;345:170–4.

Kim SJ. Drug susceptibility testing in tuberculosis: methods

and reliability of the results. Eur Respir J 2005;25:564–9.

Caminero JA. Management of multidrug-resistant

tuberculosis and patients in re-treatment. Eur Respir J


Ormerod LP. Multidrug resistant tuberculosis (MDR-TB):

epidemiology, prevention and treatment. Br Med Bull


Partners in Health Program in Infectious Disease and Social

Change, Harvard Medical School. The PIH Guide to the

Medical Management of Multi-Drug Resistant Tuberculosis.

Boston, MA. Partners in Health, 2003.

Pierri GD, Bonora S. Which agents should we use for the

treatment of multi-drug resistant Mycobacterium

tuberculosis? J Antimicrob Chemother 2004; 54:593–602.


  • There are currently no refbacks.

Contact Number: +92-992-382571

email: [jamc] [@] []