Retrospective audit of patients treated for MDR-TB in re-treatment category.
OBJECTIVE
To determine the efficacy of our modified anti-tuberculosis regimen in adult patients with multi-drug-resistant tuberculosis (MDR-TB) in the re-treatment category.


METHODS
Retrospective chart review of 176 patients in re-treatment category with diagnosis of MDR-TB from 1st Jan 1993 to 31st Dec 2002 managed at the Department of Pulmonology Military Hospital Rawalpindi, Pakistan. All the patients were given four standard first line anti-TB drugs along with any two second line drugs out of Ofloxacin/Ciprofloxacin/Levofloxacin, Amikacin, or Clarithromycin and treatment was modified after availability of drug susceptibility testing (DST).


RESULTS
Seventy-two percent of the patients were young men with mean age of 32.28 +/- 8.7 yrs, 53.4% had moderately advanced while nearly 30% had extensive disease. One-third cases had contact with a patient of pulmonary tuberculosis out of which one fifth had contact with a MDR-TB patient. Mean duration of diagnosis of tuberculosis before therapy was 41.11 +/- 14.32 months and 70% of the cases had received at least 2 prior anti-TB regimens. They had received a median of four anti-TB drugs in past and were infected with organisms that were resistant to a median of 3 first line anti-TB drugs. Resistance to Ethambutol and PZA was about 18% and 11% respectively. A median of six anti-TB drugs was used while mean duration of therapy was 22.17 +/- 2.17 months. Bacteriological cure was achieved in about 90% cases while radiological response was documented in nearly 78%.


CONCLUSIONS
Modified initial management strategy followed by DST guided therapy has yielded excellent results and needs to be assessed in further trials for wider application.
Saeed
Waseem
W
Department of Pulmonology, Military Hospital Rawalpindi, Rawalpindi, Pakistan.
Naseem
Arshad
A
Ahmed
Jamal
J
D000293:Adolescent; D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002939:Ciprofloxacin / Q000627:therapeutic use; D054908:Extensively Drug-Resistant Tuberculosis / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D006801:Humans; D064704:Levofloxacin; D008297:Male; D008875:Middle Aged; D015242:Ofloxacin / Q000627:therapeutic use; D010154:Pakistan / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D000890:Anti-Infective Agents; D000995:Antitubercular Agents; D002939:Ciprofloxacin; D064704:Levofloxacin; D015242:Ofloxacin