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Factors predicting treatment success in multi-drug resistant tuberculosis patients treated under programmatic
A K Janmeja1, Deepak Aggarwal1, Ruchika Dhillon1
1Professor & Head, Department of Pulmonary Medicine, Govt Medical College & Hospital, Sector-32, Chandigarh, India; Associate Professor, Department of Pulmonary Medicine, Govt Medical College & Hospital, Sector-32, Chandigarh, India; Sr. Medical Officer, DRTB Centre, Department of Pulmonary Medicine, Govt Medical College & Hospital, Sector-32, Chandigarh, India.
Background:
Treatment success in multi-drug resistant tuberculosis under programmatic conditions has been far from satisfactory. Knowledge of the factors predicting treatment outcome can guide us to take appropriate corrective measures for better results. However, there is a scarcity of data on these predictors in Indian patients. The present study was sought to evaluate association of different patient and disease specific factors with treatment outcome in MDR-TB patients.
Methods:
It was a retrospective study that involved evaluation of data of MDR-TB patients who were started on Cat-IV treatment between January 2012 and December 2014. Medical records of 256 patients were scrutinized and necessary information on possible predicting factors like age, gender, body mass index, co-morbidities, previous TB treatment, blood investigations, treatment adherence, culture conversion time, etc. was retrieved. These factors were analyzed for their possible association with treatment outcome.
Results:
Of the 256 patients, 132 (51.6%) achieved successful outcome after Cat-IV anti-TB regimen. On multivariate logistic regression analysis age (adjusted OR=0.95; 95% CI 0.91-0.98; p=0.01), serum albumin level (adjusted OR=3.71; 95% CI: 1.22-11.3; p=0.02) and treatment adherence (adjusted OR=4.52; 95% CI: 1.2-16.6; p=0.02) were independently associated with treatment success. Co-morbidities like diabetes and alcoholism and previous anti-TB treatment didn't affect the treatment end result significantly.
Conclusion:
The treatment outcome in MDR-TB has not significantly improved since the inception of DOTS-Plus strategy. Interventions to improve nutrition and treatment adherence might help to improve the success rate in MDR-TB treatment.
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