RETROSPECTIVE AUDIT OF PATIENTS TREATED FOR MDR-TB IN RE-TREATMENT CATEGORY

Waseem Saeed, Arshad Naseem, Jamal Ahmed

Abstract


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

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