PURPOSE: To evaluate results of treatment given to drug failure pulmonary tuberculosis patients, for formulating treatment in newer patients.
METHODS: Hospital record of past 7 years was analyzed. In all 60 such patients were encountered.
RESULTS: It is difficult to treat drug failure patients of pulmonary tuberculosis patients. Majority 50 (83%) of these patients were males. All the patients had taken anti tubercular as streptomycin, isoniazid, rifampicin, ethambutol pyrazinamide, regularly in previous years regularly in various combinations for 4-6 months. All had sputum positive at the start of the treatment. They were retreated with regimens containing cycloserine, ethionamide, isoniazid, pas and oflaxacin / sparfoxacin for one year, at least, along with kanamycin injection for 3 months. Patients were advised / motivated to continue treatment for one year after sputum conversion. It was observed that only 30 (50%) completed chemotherapy. Among them 28 (84%) achieved bacteriological quiscence. On follow for 12 to 24 months (average 14 months) 6 patients (20%) of these patients relapsed bacteriologically. Among 30 patients who took incomplete treatment (average 6 months) 6 patients (20%) achieved sputum convertion. On the whole drugs were well tolerated in most of the patients. Almost all the patients complained of high cost of treatment. The cost factor was the most common reason sited for discontinuation of treatment by patients.
CONCLUSION: Therapy with reserve drugs is very costly due to high cost of drugs and longer duration of treatment. So chances of defaults are very high. To counter this, these patients should be fully motivated to complete the course of treatment so as to stop further spread of multi drug resistant tuberculosis in the community.
CLINICAL IMPLICATIONS: Proper record keeping in treatment of pulmonary tuberculsis patients is must. Patients failing on 1st line drugs need to be treated promptly so as to prevent the further spread of resistant tuberculosis. These drugs need to be supplied free of cost to achieve this goal.
DISCLOSURE: Nirmal Chand, None.
Nirmal Chand MD * M. S. Parhar PhD Bharat Bhushan MD Satish Duggal MD Sandeep Gupta MD Jorawar Singh MBBS Dept. of TB. & Chest, Medical College Amritsar, Amritsar, India
COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group