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Initiation of MDR TB treatment: is hospitalization worth?
Background:
The treatment for MDR TB is quite prolonged and associated with adverse effects and hence costly.
Aim:
The aim of study was to study the side-effects of reserve line drugs developing in initial seven days of starting therapy, so as to weigh the need for admission for initiation of treatment against heavy economic burden by admission of huge number of MDR TB patients, and to identify the factors which may have an effect on the number of patients developing side-effects
Methods:
All MDR TB patients (930) admitted during study period, who were initiated on Cat IV treatment for MDR TB under RNTCP were questioned daily for any side-effects throughout the day, during initial seven days of treatment.
Results:
On day one, 342 (36.8%) patients developed side-effects, on 2nd day 456 (49%), on day 3 356 (38.3 %), on fourth day 257 (27.6%), then on fifth day only 172 (18.5 %) patients respectively had reported side-effects. Further decline of side-effects was reported on sixth day 94(10.1%) and seventh day 39(4.2%). Number of events also decreased from 669 on dayl and 965 on day 2, to only 61 on day 7 of treatment. Most of the patients had nausea, vomiting, pain abdomen, restlessness, dizziness, insomnia and headache. Patients with low Hemoglobin had more side-effects from day 2 onwards (p<0.05).Age, BMI, gender and co-morbidities had no significant effect on side-effects in these patients.
Conclusion:
Many patients report side-effects initially on treatment, which gradually decrease from day 4 onwards , so hospitalization for atleast seven days during initiation of Cat IV may not be required in all the patients.
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