title: Outcomes of Category III DOTS treatment in immunocompetent patients with tuberculosis pleural effusion.
abstract: OBJECTIVE
  To study the efficacy and safety of Category III DOTS treatment (intermittent thrice-weekly rifampicin [RMP], isoniazid [INH] and pyrazinamide for 2 months, followed by RMP and INH for 4 months) under India's Revised National Tuberculosis Control Programme in patients with  uncomplicated small unilateral pleural effusion (<1500 ml).
  
  
  METHODS
  This prospective, multicentre, observational study recruited 351 patients between 2006 and 2010. Patients were regularly followed up clinically as well as with ultrasound examination of the chest.
  
  
  RESULTS
  Successful  outcome (clinical response with complete resolution on ultrasound examination at 6 months) was seen in 274 patients (78.1%). Efficacy was 88.9% (excluding defaulters), and 94% among those completing follow-up as per protocol. None of the patients received corticosteroids. Other outcomes included  treatment extension (n = 26, 7.4%), default (n = 43, 12.2%), treatment failure (n = 3, 0.9%) and death (n = 3, 0.9%). Seventy-nine mild/moderate adverse events and one treatment-related serious adverse event were noted; one patient developed recurrent drug-induced  hepatotoxicity. Two patients (0.7%) had relapse/re-infection at 24 months follow-up.
  
  
  CONCLUSIONS
  Intermittent thrice-weekly treatment for 6 months with three drugs in the intensive phase is effective and safe for unilateral small pleural effusion in immunocompetent patients. Although Category  III no longer exists in the programme, the results are reassuring for intermittent treatment in extra-pulmonary TB under programme conditions.
authors.affiliation: Department of Medicine, All India Institute of Medical Sciences, New Delhi, India. sksharma.aiims@gmail.com
authors.forename: S K
authors.initials: SK
authors.lastname: Sharma
authors.forename: R
authors.initials: R
authors.lastname: Solanki
authors.forename: A
authors.initials: A
authors.lastname: Mohan
authors.forename: N K
authors.initials: NK
authors.lastname: Jain
authors.forename: L S
authors.initials: LS
authors.lastname: Chauhan
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage* / Q000009:adverse effects; D023801:Directly Observed Therapy / Q000379:methods*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007121:Immunocompetence; D007194:India; D007538:Isoniazid / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000382:microbiology; D011446:Prospective Studies; D011718:Pyrazinamide / Q000008:administration & dosage / Q000009:adverse effects; D012008:Recurrence; D012293:Rifampin / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D011718:Pyrazinamide; D007538:Isoniazid; D012293:Rifampin