Outcomes of individualised treatment for multidrug-resistant tuberculosis before DOTS-plus.
METHODS
A tuberculosis (TB) out-patient service in the city of Santa Cruz, Bolivia.


OBJECTIVE
To evaluate the outcomes of patients with TB resistant to isoniazid and rifampicin (multidrug resistance [MDR]) treated in a resource-poor area before the introduction of the DOTS-Plus initiative.


METHODS
Retrospective cohort study of MDR-TB patients treated with individualised regimens between January 1983 and December 1993.


RESULTS
Among 143 patients studied, 73 (51%) were males; the mean age was 33.9 years. Forty (28%) were new patients and 103 (72%) were previously treated patients. The treatment regimen had to be modified in 122 (85%) patients. A successful outcome was achieved in 41 (28%) patients; 68 (48%) defaulted, 18 (13%) died, and 14 (10%) were still under treatment in 1996.


CONCLUSIONS
The treatment approach described had dismal results. The capacity for performing drug susceptibility testing and the availability of several second-line anti-tuberculosis drugs were not sufficient to achieve cure in more than one third of the patients treated. Other factors, such as a set of standard procedures, clear guidelines for the treatment and follow-up of patients and the administration of directly observed treatment, must be included in a programme for treating MDR-TB, to obtain better treatment results.
Ollé-Goig
J E
JE
St Francis Hospital, Buluba, Uganda. olleuganda@yahoo.com
Sandy
R
R
D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage; D023801:Directly Observed Therapy; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy*
D000995:Antitubercular Agents