Analysis of treatment outcome in multi-drug resistant tuberculosis patients treated under programmatic conditions

Janmeja, Ashok Kumar; Aggarwal, Deepak; Dhillon, Ruchika

doi:10.18203/2320-6012.ijrms20172122

Cited by 8 publications

(14 citation statements)

References 10 publications

(15 reference statements)

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“…In our study, the culture conversion rate was 87.7%, which was in accordance with previous studies reporting conversion rates ranging from 74% to 92%,[56181920212223242526] suggesting that adoption of the modified DOTS-Plus strategy might be a cost-effective strategy, particularly in high MDR-burden resource-limited setting like India. Reduction in culture examinations in the continuation phase can also help in diversion of available resources in further expansion of the existing program to cater to unmet populations.…”

Section: Discussionsupporting

confidence: 91%

Treatment outcome of multidrug-resistant tuberculosis with modified DOTS-plus strategy: A 2 years' experience

et al. 2019

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Background: Multidrug-resistant tuberculosis (MDR-TB) is a global health problem with notoriously difficult and challenging treatment. This study determined treatment outcome in patients of MDR-TB with modified DOTS-Plus strategy. Methods: Ninety-eight consecutive MDR-TB patients treated with standardized regimen according to modified DOTS-Plus strategy aligned to the existing national DOTS-Plus guidelines with relevant modifications proposed by Chennai consensus were analyzed prospectively. Treatment included monthly follow-up with clinical, radiological, and bacteriological assessment (sputum smear advised monthly till conversion then quarterly; culture for Mycobacterium tuberculosis at 0, 4, 6, 12, 18, and 24 months), ensuring adherence, intense health education, and monitoring of adverse events (AEs). Patients' outcome was considered as cure when at least two of the last three cultures (all three or last two) were negative and as failure when the same were positive. Results: Favorable and unfavorable outcomes in this cohort were reported to be 71/98 (72.4%) and 27/98 (27.6%) (failure – 10 [10.2%], default – 7 [7.1%], and expiry – 10 [10.2%]), respectively. Sputum smear and culture conversion rate were 75/81 (92.5%) and 71/81 (87.7%), respectively. Major AEs were experienced in only 17.4% of patients. Conclusions: MDR-TB can be cured successfully with modified DOTS-Plus strategy and requires much effort from both the patients and health-care workers. It can be an alternative model for treating MDR-TB patients in private sector.

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Section: Discussionsupporting

confidence: 91%

Treatment outcome of multidrug-resistant tuberculosis with modified DOTS-plus strategy: A 2 years' experience

et al. 2019

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“…The majority of patients (78%) in this study had a sputum culture conversion at 6 months with median time of sputum smear and culture conversion at 3 months. A sputum culture conversion rate of 90% was achieved in our cohort which is higher than the conversion rates of 81.4% and 82.1% reported in two recent studies [25,26]. In spite of better Rwandan programme performance in term of successful outcome, high sputum/culture conversion and very low rates of treatment failure (0.6%) and loss to follow-up (0.6%), the rate of death among MDR-TB patients with unfavourable treatment outcome was an alarming finding of our study.…”

Section: Discussioncontrasting

confidence: 78%

Highly successful treatment outcome of multidrug‐resistant and genetic diversity of multidrug‐resistant Mycobacterium tuberculosis strains in Rwanda

Muvunyi

Ngabonziza

Uwimana

et al. 2019

Tropical Med Int Health

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Objective To determine prevalent MDR‐TB genotypes and describe treatment outcome and bacteriology conversion in MDR‐TB patients. Methods Review of laboratory records of 173 MDR‐TB patients from all over Rwanda who initiated treatment under programmatic management of MDR‐TB (PMDT) between 2014 and 2015. Fifty available archived isolates were genotyped by mycobacterial interspersed repetitive units – variable number of tandem repeats (MIRU‐VNTR) genotyping. Result Of the 170 patients whose outcome was known, 114 (66.3%) were cured and 36 (21%) completed the treatment, giving a successful outcome (cured and completed) of 150 (87.3%) patients. Of 20 MDR‐TB patients with unfavourable treatment outcome, 18 died, one failed and one defaulted/stopped treatment. Of the 18 patients who died, 11 (61%) were HIV‐coinfected. The treatment outcome was successful for 93.9% among HIV negative and 81.8% among HIV‐coinfected patients (P = 0.02). Sputum smear conversion occurred in 3, 46, 57 and 78 patients before 2, 3, 4 and 6 months, respectively, with median time of sputum smear and culture conversion at 3 months. The 44 MDR‐TB isolates with MIRU‐VNTR result, showed high genetic diversity with low clustering rate (9.09%) and Uganda II being the most prevalent sub‐family lineage detected in 68.2% of isolates. Beijing family was the least common genotype detected (2.3%, 1 isolate). Conclusion The high success rates for MDR‐TB treatment achieved in Rwanda were comparable to outcomes observed in resource‐rich settings with HIV being an independent risk factor for poor treatment outcome. High genetic diversity and low clustering rate reported here suggest that reactivation of previous disease plays an important role in the transmission of MDR‐TB in Rwanda.

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“…[14][15][16] Majority of the cases (69.2%)were sputum positive retreatment cases which was in agreement with most of the other Indian studies and systematic reviews. [17][18][19] Sputum culture conversion at 3 rd month occurred in 56.7% of cases, which was low compared to other studies by Sachin S Dole et al and Deepak et al 12,13 But sputum culture conversion at end of 6 months was 83.9%, which was in agreement with other recent Indian studies, systematic reviews, and Meta-analysis.…”

Section: Discussionsupporting

confidence: 86%

“…In this study successful outcome was observed in 54.54%which was similar to a study done by Sachin S Dole et al, Sangita V. Patela et al study had a very low successful outcome (38.62%), and in a study by Deepak et al and in a systematic review of 36 studies the successful outcomes were 63% and 62% respectively. [11][12][13]18 In this study 21.6% of cases died which was in contrast to other studies ranging from 11% to 16.4 %. High death rate might be because of comorbidities and bilateral extensive i.e.…”

Section: Discussioncontrasting

confidence: 73%

“…10 The demographic profile of MDR-TB patients in this study was similar to that of studies done by Sangita et al (2010), Sachin S Dole et al (2016), and Deepak et al (2017). [11][12][13] Majority of the patients were in the economically productive age group (20-40 years). In this study, there were few patients with HIV infection and these patients had worse outcomes than those who were HIV-negative.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of multi drug resistant tuberculosis under programmatic conditions: the experience

Yellapu

Koyyana

Nammi³

et al. 2020

Int J Res Med Sci

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Background: Tuberculosis is the most common cause of death from an infectious disease worldwide after HIV/AIDS. Drug resistant tuberculosis continues to be a public health crisis. India stands, one among 27 “high burden” MDR countries and has over 2 million new TB cases every year and TB kill’s nearly 1000 people every day. The WHO 2018 Global Tuberculosis Report estimated that, worldwide, approximately 3.5 percent of all new TB cases and 18 percent of previously treated cases are caused by MDR or rifampicin-mono resistant strains.Methods: Presumptive drug resistance TB cases were subjected for CBNAAT or LPA to detect resistance patterns. About 231 cases of MDR/RR TB cases after pre-treatment evaluation started on CAT- IV regimen and both interim and final outcomes were analyzed.Results: Out of 231cases 172(74.4%) were males and 59(25.6%) were females with age between 13-75yrs. Total of 194 cases culture conversion occurred out of which 28 cases the cultures were reverted back to positives. Final Outcomes were, cured in 84 (36.3%) cases, treatment completed in 42 (18.18%) cases, defaulters in 31 (13.4%) cases, turned to be XDR in 10 (4.32%) cases, treatment failure in 10 (4.32%) cases, 50 (21.6%) cases died, 3(1.29%) cases were transferred out.Conclusions: Approximately 2/3rd of MDR/RR TB cases are retreatment sputum positive cases. Successful outcome observed in 54.54% of cases only. High rates of deaths and defaulters alarm the necessity of more effective implementation and surveillance of the programme.

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Analysis of treatment outcome in multi-drug resistant tuberculosis patients treated under programmatic conditions

Cited by 8 publications

References 10 publications

Treatment outcome of multidrug-resistant tuberculosis with modified DOTS-plus strategy: A 2 years' experience

Treatment outcome of multidrug-resistant tuberculosis with modified DOTS-plus strategy: A 2 years' experience

Highly successful treatment outcome of multidrug‐resistant and genetic diversity of multidrug‐resistant Mycobacterium tuberculosis strains in Rwanda

Outcomes of multi drug resistant tuberculosis under programmatic conditions: the experience

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