Long term treatment outcome in multi drug resistant tuberculosis

Background: Multi Drug Resistant tuberculosis (MDR-TB) is an increasing worldwide problem which is difficult to treat and has greater risk of relapse. Aims and Objective: To analyze long term treatment outcome with second line drugs in patients with MDR-TB. Methods: A descriptive analyses of 93 consecutive patients with MDR-TB attending the Dept of Pulmonary Medicine, CSMMU, between June 1998 to February 2008 with follow-up till December 2010. All patients were admitted for average duration of 70 days and received a regimen chosen from Kanamycin, PAS, Ethionamide, Cycloserine, Flouroquinolone, Isoniazid, Ethambutol and Pyrazinamide. Patients outcome was considered as cure when atleast two of the last three (At 12, 18 & 24 m) cultures were negative and as failure when the same were positive. Results: All the patients had resistance to at least Isoniazid and Rifampicin with mean no. of 3.38 drugs. Average duration of pretreatment chemotherapy was 34.5 (10-62) months. Out of 93 patients enrolled, 75 completed the treatment as planned, 5 patients died during treatment, and 13 patients abandoned it or lost to follow up. Considering the best scenario cure rate was 93.33% (70/75) and in worst scenario cure rate was 75.27 % (70/93). Out of 75 cured, 68 came for follow-up for mean duration of 53.3 (10-98) months.Relapse rate was 9.33%(7/75). Significant side effects were experienced in 13 (13.98%) patients. Conclusions: In MDR-TB patients, regimen consisting of Ethionamide, PAS, fluoroquinolone and Cycloserine with injection Kanamycin in initial 4-8 months appears to be safe and effective. MDR TB can be cured successfully with appropriate combination chemotherapy for an adequate duration requiring a strategic approach.