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

Abstract

Objective: To determine the efficacy of our modified anti-tuberculosis regimen in adult patients withmulti-drug-resistant tuberculosis (MDR-TB) in the re-treatment category. Methods: Retrospective chartreview of 176 patients in re-treatment category with diagnosis of MDR-TB from 1st Jan 1993 to 31st Dec2002 managed at the Department of Pulmonology Military Hospital Rawalpindi, Pakistan. All the patientswere given four standard first line anti-TB drugs along with any two second line drugs out ofOfloxacin/Ciprofloxacin/Levofloxacin, Amikacin, or Clarithromycin and treatment was modified afteravailability of drug susceptibility testing (DST). Results: Seventy-two percent of the patients were youngmen with mean age of 32.28±8.7 yrs, 53.4% had moderately advanced while nearly 30% had extensivedisease. One-third cases had contact with a patient of pulmonary tuberculosis out of which one fifth hadcontact with a MDR-TB patient. Mean duration of diagnosis of tuberculosis before therapy was41.11±14.32 months and 70% of the cases had received at least 2 prior anti-TB regimens. They hadreceived a median of four anti-TB drugs in past and were infected with organisms that were resistant to amedian 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±2.17months. Bacteriological cure was achieved in about 90% cases while radiological response wasdocumented in nearly 78%. Conclusion: Modified initial management strategy followed by DST guidedtherapy 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