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Clinical characteristics and treatment response among patients with multidrug-resistant tuberculosis: a retrospective
H S Subhash1, I Ashwin, M V Jesudason
1Department of Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India. hssubhashcmc@hotmail.com
Background:
This retrospective study was conducted to evaluate the characteristics and therapeutic response among patients with multidrug-resistant tuberculosis (MDR TB).
Methods:
One hundred subjects with isolates resistant to isoniazid and rifampicin were included over a three-year period (1997-1999). There were 82% males with a mean age of 36 years, mean duration of symptoms of 29 months, and a previous history of tuberculosis in 85% (pulmonary 96% and extrapulmonary 4%).
Results:
HIV ELISA test was positive in two out of 28 (7%) patients while diabetes was diagnosed in 16 percent. Mean time to diagnose MDR TB was 5.5 months. Subjects had received a mean of 3.2 anti-TB drugs before the diagnosis of MDR TB was made. Forty-five patients were lost to follow-up. The rest had a median follow-up of 13.5 months (range 1-37 months). Follow-up AFB smear and culture results were available in 49 out of 55 and 26 out of 55 patients, respectively. Sputum smear became negative for AFB in 26 out of 49 (53%) and culture converison occurred in 16 out of 26 (61.5%) patients. Clinical and radiological response was noted in 31 (56%) and 13 (32.5%) out of 40 patients respectively. A mean of 5.5 drugs was used in those who achieved sputum conversion. Combination therapy containing ofloxacin in the regimen was noted to have a favourable response.
Conclusion:
Only a limited number of patients with MDR tuberculosis have a favourable response.