Efficacy and safety of kanamycin, ethionamide, PAS and cycloserine in multidrug-resistant pulmonary tuberculosis patients.
BACKGROUND
We carried out this study to determine the efficacy and safety of a regimen containing kanamycin, ethionamide, isoniazid, para-aminosalicylic acid (PAS) and cycloserine in the treatment of multidrug-resistant tuberculosis (MDR-TB).


METHODS
A prospective, uncontrolled study of 39 pulmonary tuberculosis patients, who had received adequate first-line antituberculosis treatment including supervised category II retreatment regimen, and were still sputum smear positive for acid-fast bacilli (AFB) in whom sputum culture revealed isolates of M. tuberculosis resistant to rifampicin and isoniazid with and without resistance to other antituberculosis drugs. They received kanamycin (initial 4-6 months), ethionamide, isoniazid, PAS and cycloserine for a minimum period of two years.


RESULTS
Out of 39 patients, 29 (74.3%) achieved sputum conversion within six months and remained so at the end of two years. Two (5.1%) patients died, six (20.6%) patients were lost to follow up, and two (5.1%) patients remained sputum smear-positive for AFB through out the period of study. Twenty-nine patients, declared cured, were followed for an average period of 16 months (3-48 months), during which two (6.9%) patients relapsed, four (13.8%) patients were lost to follow-up and remaining 23 remained sputum smear-negative. Eight (21.1%) patients developed major side effects which required stoppage/change of drugs.


CONCLUSIONS
In MDR-TB patients, regimen consisting of ethionamide, isoniazid, PAS and cycloserine and kanamycin appears to be effective and safe.
Prasad
R
R
Department of Pulmonary Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India. rprasad2@sancharnet.in
Verma
S K
SK
Sahai
S
S
Kumar
S
S
Jain
A
A
D000293:Adolescent; D000328:Adult; D010131:Aminosalicylic Acid / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use*; D003523:Cycloserine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005000:Ethionamide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007612:Kanamycin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013183:Sputum / Q000382:microbiology; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000382:microbiology
D000995:Antitubercular Agents; D007612:Kanamycin; D010131:Aminosalicylic Acid; D003523:Cycloserine; D005000:Ethionamide