How do patients who fail first-line TB treatment but who are not placed on an MDR-TB regimen fare in South India?
METHODS
Seven districts in Andhra Pradesh, South India.


OBJECTIVE
To a) determine treatment outcomes of patients who fail first line anti-TB treatment and are not placed on an multi-drug resistant TB (MDR-TB) regimen, and b) relate the treatment outcomes to culture and drug susceptibility patterns (C&DST).


METHODS
Retrospective cohort study using routine programme data and Mycobacterium TB Culture C&DST between July 2008 and December 2009.


RESULTS
There were 202 individuals given a re-treatment regimen and included in the study. Overall treatment outcomes were: 68 (34%) with treatment success, 84 (42%) failed, 36 (18%) died, 13 (6.5%) defaulted and 1 transferred out. Treatment success for category I and II failures was low at 37%. In those with positive cultures, 81 had pan-sensitive strains with 31 (38%) showing treatment success, while 61 had drug-resistance strains with 9 (15%) showing treatment success. In 58 patients with negative cultures, 28 (48%) showed treatment success.


CONCLUSIONS
Treatment outcomes of patients who fail a first-line anti-TB treatment and who are not placed on an MDR-TB regimen are unacceptably poor. The worst outcomes are seen among category II failures and those with negative cultures or drug-resistance. There are important programmatic implications which need to be addressed.
Office of the WHO Representative in India, New Delhi, India. sharathb@rntcp.org
Sharath
S
Burugina Nagaraja
Srinath
S
Satyanarayana
Sarabjit Singh
SS
Chadha
Santosha
S
Kalemane
Jyoti
J
Jaju
Shanta
S
Achanta
Kishore
K
Reddy
Vishnu
V
Potharaju
Srinivas Rao Motta
SR
Shamrao
Puneet
P
Dewan
Zachariah
Z
Rony
Shailaja
S
Tetali
Raghupathi
R
Anchala
Nanda Kishore
NK
Kannuri
Anthony David
AD
Harries
Sachdeva Kuldeep
SK
Singh
D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002648:Child; D006801:Humans; D007194:India; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D017211:Treatment Failure; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy*; D055815:Young Adult
D000995:Antitubercular Agents