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.
Department of Pulmonology, Military Hospital Rawalpindi, Rawalpindi, Pakistan.
Waseem
W
Saeed
Arshad
A
Naseem
Jamal
J
Ahmed
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