title: Management of multi drug resistance tuberculosis in the field: Tuberculosis Research Centre experience.
abstract: METHODS
  Multi-drug TB resistant (resistant to isoniazid and rifampicin) patients identified from a rural and urban area.
  
  
  OBJECTIVE
  To study the feasibility of managing MDR TB patients under field conditions where DOTS programme has been implemented.
  
  
  METHODS
  MDR TB Patients identified among patients treated under DOTS in the rural area and from cases referred by the NGO when MDR TB was suspected form the study population. Culture and drug susceptibility testing were done at Tuberculosis Research Centre (TRC). Treatment regimen was decided on individual basis. After a period of initial hospitalization, treatment was continued in the respective peripheral health facility or with the NGO after identifying a DOT provider in the field. Patients attended TRC at monthly intervals for clinical, sociological and bacteriological evaluations. Drugs for the month were pre-packed and handed over to the respective center.
  
  
  RESULTS
  A total of 66 MDR TB patients (46 from the rural and 20 from the NGO) started on treatment form the study population and among them 20 (30%) were resistant to one or more second line drugs (Eto, Ofx, Km) including a case of "XDR TB". Less than half the patients stayed in the hospital for more than 10 days. The treatment was provided partially under supervision. Providing injection was identified to be a major problem. Response to treatment could be correctly predicted based on the 6-month smear results in 40 of 42 regular patients. Successful treatment outcome was observed only in 37% of cases with a high default of 24%. Adverse reactions necessitating modification of treatment was required only for three patients.
  
  
  CONCLUSIONS
  Despite having reliable DST and drug logistics, the main challenge was to maintain patients on such prolonged treatment by identifying a provider closer to the patient who can also give injection, have social skills and manage of minor adverse reactions.
authors: Tuberculosis Research Centre, Channai.
authors: Aleyamma
authors: A
authors: Thomas
authors: Rajeswari
authors: R
authors: Ramachandran
authors: Fathima
authors: F
authors: Rehaman
authors: K
authors: K
authors: Jaggarajamma
authors: T
authors: T
authors: Santha
authors: N
authors: N
authors: Selvakumar
authors: Nalini
authors: N
authors: Krishnan
authors: Nalini Sunder
authors: NS
authors: Mohan
authors: V
authors: V
authors: Sundaram
authors: Fraser
authors: F
authors: Wares
authors: P R
authors: PR
authors: Narayanan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007194:India; D007538:Isoniazid / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011634:Public Health; D012293:Rifampin / Q000627:therapeutic use; D012424:Rural Population; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000628:therapy*; D014505:Urban Population
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid; D012293:Rifampin