Treatment outcome of multi drug resistant tuberculosis patients in modified DOTS-PLUS: A new strategy

Background: Multi Drug Resistant Tuberculosis is a worldwide problem and growing hazard to human health. Aims and Objective: To study the treatment outcome with second line drugs in patients of MDR-TB in modified DOTS-PLUS strategy. Methods: A prospective cohort study analysing 98 consecutive patients with MDR-TB attending the Dept of Pulmonary Medicine, CSMMU, between June 2009 to Feb 2010 with follow-up till Feb 2011. All the patients were given medications free of cost as per DOTS PLUS Protocol of India.Treatment included monthly followup,adherence check up,radiological and bacteriological assessment (sputum smear-monthly till conversion then quarterly;culture for MTB-0,4,6,12,18,24 months),health education and monitoring of adverse effects.Patients' outcome considered as “cure” when atleast 2of the last 3 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 3.02 drugs and were seronegative for HIV. Default rate at the end of 6 months and 12 months were observed in 2.1% and 4.1% patients respectively. 5 patients expired in initial 6 months and 2 in next 6 months. Sputum smear and culture conversion at the end of 6 months and 12 months were 80/90 (88.9%) and 75/90 (83.3%) and 81/87 (93.1) and 78/87 (89.7%) respectively. Mean smear and culture conversion time were 3.6±2.1 months and 4.1±2.6 months respectively. Significant side effects were experienced in 14.3% patients. Conclusions: Culture conversion rates at the end of 6 months and 12 months were 83.3% and 89.7% respectively. Modified DOTS-PLUS strategy can be model for treatment of MDR-TB in private sector.