Document Detail


Outcome of multi-drug resistant tuberculosis cases treated by individualized regimens at a tertiary level clinic.
MedLine Citation:
PMID:  18361306     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIM: To determine the clinical, radiological and drug resistance profile as well as the factors associated with treatment outcome of Multi-Drug Resistant Tuberculosis (MDR-TB). MATERIAL AND METHODS: All newly diagnosed patients with pulmonary MDR-TB from August 2002 to December 2004 enrolled at New Delhi Tuberculosis Centre, were included in the study. They were followed up clinically, radiologically and bacteriologically by sputum smear, culture and Drug Susceptibility Testing (DST) at regular intervals. According to their DST pattern and previous history of Anti-Tubercular Treatment (ATT), individualized treatment regimens were tailored for each patient. RESULTS: Out of total 27 bacteriologically proven cases of MDR-TB included in this study, 19 were males (mean age and weight 38.5 years and 52.6 kgs, respectively) and eight females (mean age and weight 34.3 years and 40.7 kgs, respectively). A majority (18) were residents of Delhi and the rest hailed from different parts of North India. All of them had a history of previous treatment ranging from six to 34 months. Cavity on chest X-rays was seen in 81%, while 44% showed extensive involvement. The patients received at least four "second line drugs" during their treatment with a mean of 6.2 anti-tubercular drugs during their intensive phase. Of the 27 patients, 13 were cured, 10 defaulted, one died, one is still on treatment and two were referred for surgery. Radiological improvement was observed in two third of cases and chest X-ray of two patients showed a complete resolution. Six predictors were identified for successful outcome of MDR-TB. They include weight gain at six months, culture conversion, radiological improvement during treatment, disease with M. tuberculosis strains exhibiting resistance to less than or up to three anti-tubercular drugs, use of less than or up to three second line drugs in treatment and no change of regimen during treatment. CONCLUSION: Default from treatment was observed to be a major challenge in the treatment of MDR-TB due to long duration and expense of ATT.
Authors:
V K Dhingra; S Rajpal; Anshu Mittal; M Hanif
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Indian journal of tuberculosis     Volume:  55     ISSN:  0019-5707     ISO Abbreviation:  Indian J Tuberc     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2008-03-25     Completed Date:  2008-05-29     Revised Date:  2009-11-19    
Medline Journal Info:
Nlm Unique ID:  0373027     Medline TA:  Indian J Tuberc     Country:  India    
Other Details:
Languages:  eng     Pagination:  15-21     Citation Subset:  IM    
Affiliation:
New Delhi Tuberculosis Centre, Jawaharlal Nehru Marg, New Delhi-110 002.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aminoglycosides / administration & dosage,  therapeutic use
Aminosalicylic Acid / administration & dosage,  therapeutic use
Antitubercular Agents / administration & dosage,  therapeutic use*
Child
Cycloserine / administration & dosage,  therapeutic use
Ethambutol / administration & dosage,  therapeutic use
Female
Fluoroquinolones / administration & dosage,  therapeutic use
Follow-Up Studies
Humans
Male
Microbial Sensitivity Tests
Middle Aged
Pyrazinamide / administration & dosage,  therapeutic use
Severity of Illness Index
Thioamides / administration & dosage,  therapeutic use
Time Factors
Treatment Outcome
Tuberculosis, Multidrug-Resistant / drug therapy*,  radiography
Chemical
Reg. No./Substance:
0/Aminoglycosides; 0/Antitubercular Agents; 0/Fluoroquinolones; 0/Thioamides; 65-49-6/Aminosalicylic Acid; 68-41-7/Cycloserine; 74-55-5/Ethambutol; 98-96-4/Pyrazinamide

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