title: Is one sputum specimen as good as two during follow-up cultures for monitoring multi drug resistant tuberculosis patients in India?
abstract: BACKGROUND
  In India, the Revised National Tuberculosis Control Programme (RNTCP) has adopted the strategy of examining two specimens during follow-up culture examinations to monitor the treatment response of multi-drug resistant tuberculosis (MDR-TB) patients.
  
  
  OBJECTIVE
  To determine the incremental yield of the second sputum specimen during follow-up culture examinations among patients with MDR-TB and the effect on case management on changing from two to one specimen follow-up strategy.
  
  
  METHODS
  A cross sectional record review of MDR-TB patients registered during 2008-09 under RNTCP was undertaken in three MDR-TB treatment sites of India.
  
  
  RESULTS
  Of 1721 pairs of follow-up sputum culture examinations done among 220 MDR-TB patients, 451(26%) were positive with either of the two specimens; 29(1.7%) were culture positive only on the second specimen indicating the incremental yield. To detect one additional culture positive result on the second specimen, 59 specimens needed to be processed. If we had examined only one specimen, we would have missed 29 culture-positive results. By current RNTCP guidelines, however, a single specimen policy would have altered case management in only 3(0.2%) instances, where patients would have missed a one month extension of the intensive phase of MDR-TB treatment. There is no meaningful advantage in using two specimens for the monitoring of MDR-TB patients. A single specimen policy could be safely implemented with negligible clinical effect on MDR-TB patients and favourable resource implications for RNTCP.
authors.affiliation: Office of the WHO-Representative in India, World Health Organization, New Delhi, India. sharathb@rntcp.org
authors.forename: Sharath Burugina
authors.initials: SB
authors.lastname: Nagaraja
authors.forename: Ajay M V
authors.initials: AM
authors.lastname: Kumar
authors.forename: Kuldeep Singh
authors.initials: KS
authors.lastname: Sachdeva
authors.forename: Ranjani
authors.initials: R
authors.lastname: Ramachandran
authors.forename: Srinath
authors.initials: S
authors.lastname: Satyanarayana
authors.forename: Avi
authors.initials: A
authors.lastname: Bansal
authors.forename: Malik
authors.initials: M
authors.lastname: Parmar
authors.forename: Sarabjit
authors.initials: S
authors.lastname: Chadha
authors.forename: Sreenivas
authors.initials: S
authors.lastname: Nair
authors.forename: Ashok
authors.initials: A
authors.lastname: Kumar
authors.forename: Sven Gudmund
authors.initials: SG
authors.lastname: Hinderaker
authors.forename: Mary
authors.initials: M
authors.lastname: Edginton
authors.forename: Puneet K
authors.initials: PK
authors.lastname: Dewan
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D019090:Case Management; D003430:Cross-Sectional Studies; D005500:Follow-Up Studies; D006801:Humans; D007194:India; D008826:Microbial Sensitivity Tests; D013183:Sputum / Q000382:microbiology*; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000995:Antitubercular Agents