Background Observational studies have demonstrated the effectiveness of a fluoroquinolone-based regimen to treat individuals presumed to be infected with drug-resistant tuberculosis (DR-TB). We sought to assess the feasibility of this approach in an urban setting in South Asia. Methods From February 2016 until March 2017, all household contacts of DR-TB patients enrolled at the Indus Hospital were screened for TB symptoms at home. Children aged 0–17 years, symptomatic adults, and those with an immunocompromising condition (human immunodeficiency virus, diabetes, or malnutrition) were evaluated for TB disease. Contacts diagnosed with TB disease were started on treatment. Contacts without TB disease aged <5 years, contacts aged between 5 and 17 years with either a positive tuberculin skin test or an immunocompromising condition, or contacts aged ≥18 years with an immunocompromising condition were offered 6 months of treatment with a fluoroquinolone. Results One hundred households with 800 contacts were enrolled: 353 (44.1%) individuals aged ≤17 years with a median age of 19 years (interquartile range, 10–32); 423 (52.9%) were males. In total, 737 (92.1%) individuals were screened, of which 8 were already on treatment for TB (1.1%); another 3 (0.4%) contacts were diagnosed with TB disease and started on treatment. Of 215 eligible for infection treatment, 172 (80.0%) contacts initiated and 121 (70.3%) completed treatment. No TB disease or significant adverse events were observed during 12 months of follow-up. Conclusions Fluoroquinolone-based treatment for contacts with presumed DR-TB infection is feasible and well tolerated in a high TB burden setting.
Background: The high burden of multi-drug resistance tuberculosis (MDR TB) is a matter of great concern. The increasing resistance to anti tuberculosis drugs has been the area of growing concern and are posing threats to TB control. The aim of this study was to evaluate the drug resistance patterns for the first line and second line anti-Tuberculosis drugs in multiple drug resistant tuberculosis (MDR-TB) patients. Method: The study was retrospective, observational, employing purposive, non-random sampling technique for data collection conducted at the TB Clinic-of the different healthcare centers in the provinces of Pakistan Sindh and Baluchistan from December 2010 to May 2016. All bacteriologically confirmed TB patients who were found to be Rifampin Resistant (RR) on Genotypic drug susceptibility testing (GXP), or detected to be drug resistant on phenotypic Universal drug susceptibility testing were enrolled into the study. Results: Out of total 3776 patients, 96.3% were resistant to Rifampicin and 94.7% were resistant to Isoniazid. 25.5% isolates were resistant to all five first line drugs. Resistances against Pyrazinamide and Ethambutol was 54.2% and 51.6% respectively. 36.3% patients were resistant to Fluoroquinolones (FQ), 9.7% were resistant to Ethionamide (Eto) and 4.1% were resistant to both FQ and Eto. 33.5% patients were MDR plus resistant to FQ. However, the resistance to both FQ plus Aminogycosides was quite low, 2.7%. Conclusion: The drug resistance rates are quiet high in MDR-TB for both first line and second line drugs. The standardized MDR TB regimen needs to be updated, based on the prevalence of drug resistance patterns in the community for the effective management of drug resistant TB.
Background: Multi-Drug Resistant Tuberculosis (MDRTB) is difficult to treat form of TB, retreatment of MDRTB patients is a more difficult area as patients have modified drug resistant patterns, more number of least effective drugs on the regimen and the cure rates are low. Objectives: The Objectives of this study were to estimate the time to culture conversion and factors associated with failure to culture conversion, six months interim outcomes and associated risk factors with poor interim outcomes in MDRTB patients who had been previously treated with second line drugs. Methods: The study was Prospective clinical case series study. All bacteriologically confirmed MDRTB retreatment patients enrolled between March-2016 to January-2017 at TB Clinic: The Indus Hospital and seven other Programmatic Management of Drug Resistant Tuberculosis (PMDT) sites (n=266) running under the umbrella of TB Clinic-The Indus Hospital were enrolled into the study. Results: Overall, 40.1% of MDR retreatment patients experienced poor interim outcome. Poor interim outcomes were significantly associated with higher number of drugs on the regimen, (OR= 1.27, 95% CI: 1.03-1.58) and high sputum smear grading (OR=4.56, 95% CI: 3.30-18.71). Almost 70.3% patients experienced culture conversion within initial six months of treatment. Conclusion: The success rate of retreatment of MDRTB with conventional regimen is unacceptably low. Key words: Multi-drug Resistant Tuberculosis, Second Line Drugs, Culture Conversion, Interim Outcomes, Sputum Smear Microscopy
Background: Pakistan ranks sixth amongst the twenty-two TB high-burden countries in the world, accounting for one of the major health problems in Pakistan. Substance abuse is the most commonly reported behavioral risk factor among TB patients.
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