title: Management and treatment outcomes of MDR-TB: results from a setting with high rates of drug resistance.
abstract: METHODS
  Although Pakistan has a high burden of multidrug-resistant tuberculosis (MDR-TB), little is known about the management and treatment outcomes of MDR-TB patients in Pakistan.
  
  
  OBJECTIVE
  To evaluate management and predictors of unsuccessful treatment outcomes among MDR-TB patients.
  
  
  METHODS
  In this observational cohort study, 196 MDR-TB patients enrolled at the Programmatic Management Unit for drug-resistant TB of Lady Reading Hospital, Peshawar, Pakistan, between 1 January 2012 and 28 February 2013 were included. Patients were followed until an outcome was recorded or 31 January 2015.
  
  
  RESULTS
  Extensive concurrent resistance to ofloxacin (OFX) and pyrazinamide (54.6%) was observed. Among 181 patients for whom treatment outcome was available, 135 (74.6%) were cured, 1 (0.6%) completed treatment, 35 (19.3%) died, 8 (4.4%) failed treatment and 2 (1.1%) defaulted. In multivariate analysis, predictors of unsuccessful treatment outcome (death, failure and default) were age >40 years (OR 3.412, P = 0.009), baseline body weight <40 kg (OR 2.966, P = 0.020), concurrent comorbidity (OR 3.785, P = 0.023), resistance to OFX (OR 2.777, P = 0.023), lung cavitations at baseline chest X-ray (OR 5.253, P < 0.001) and regimen modification due to adverse events (OR 3.492, P = 0.037).
  
  
  CONCLUSIONS
  The treatment outcome results were encouraging. Patients with identifiable predictors of poor treatment outcome should receive enhanced clinical management. Early detection and management of mild adverse effects can help prevent regimen modification and may improve treatment outcomes.
authors.affiliation: Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.
authors.forename: N
authors.initials: N
authors.lastname: Ahmad
authors.affiliation: Department of Pulmonology, Postgraduate Medical Institute, Peshawar.
authors.forename: A
authors.initials: A
authors.lastname: Javaid
authors.affiliation: Department of Pulmonology, Postgraduate Medical Institute, Peshawar.
authors.forename: A
authors.initials: A
authors.lastname: Basit
authors.affiliation: Department of Pulmonology, Postgraduate Medical Institute, Peshawar.
authors.forename: A K
authors.initials: AK
authors.lastname: Afridi
authors.affiliation: Peshawar Medical College, Peshawar.
authors.forename: M A
authors.initials: MA
authors.lastname: Khan
authors.affiliation: Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan.
authors.forename: I
authors.initials: I
authors.lastname: Ahmad
authors.affiliation: Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.
authors.forename: S A S
authors.initials: SA
authors.lastname: Sulaiman
authors.affiliation: Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.
authors.forename: A H
authors.initials: AH
authors.lastname: Khan
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D004334:Drug Administration Schedule; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015242:Ofloxacin / Q000627:therapeutic use*; D010154:Pakistan; D011718:Pyrazinamide / Q000627:therapeutic use*; D017211:Treatment Failure; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D011718:Pyrazinamide; D015242:Ofloxacin