Management of Multi Drug Resistance Tuberculosis in the Field: Tuberculosis Research Centre Experience

Thomas, A and Ramachandran, Rajeswari and Rehaman, Fathima and Jaggarajamma, K and Santha, T and Selvakumar, N and Krishnan, N and Sunder Mohan, Nalini and Sundaram, V and Wares, F and Narayanan, P R (2007) Management of Multi Drug Resistance Tuberculosis in the Field: Tuberculosis Research Centre Experience. Indian Journal of Tuberculosis, 54 (3). pp. 117-124. ISSN 0019-5705

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Setting: Multi-drug TB resistant (resistant to isoniazid and rifampicin) patients identified from a rural and urban area. Objective: To study the feasibility of managing MDR TB patients under field conditions where DOTS programme has been implemented Methods: MDR TB Patients identified among patients treated under DOTS in the rural area and from cases referred by the NGO when MDR TB was suspected form the study population. Culture and drug susceptibility testing were done at Tuberculosis Research Centre (TRC). Treatment regimen was decided on individual basis. After a period of initial hospitalization, treatment was continued in the respective peripheral health facility or with the NGO after identifying a DOT provider in the field. Patients attended TRC at monthly intervals for clinical, sociological and bacteriological evaluations. Drugs for the month were pre-packed and handed over to the respective center. Results: A total of 66 MDR TB patients (46 from the rural and 20 from the NGO) started on treatment form the study population and among them 20 (30%) were resistant to one or more second line drugs (Eto, Ofx, Km) including a case of “XDR TB”. Less than half the patients stayed in the hospital for more than 10 days. The treatment was provided partially under supervision. Providing injection was identified to be a major problem. Response to treatment could be correctly predicted based on the 6-month smear results in 40 of 42 regular patients. Successful treatment outcome was observed only in 37% of cases with a high default of 24%. Adverse reactions necessitating modification of treatment was required only for three patients. Implications Despite having reliable DST and drug logistics, the main challenge was to maintain patients on such prolonged treatment by identifying a provider closer to the patient who can also give injection, have social skills and manage of minor adverse reactions.

Item Type: Article
Uncontrolled Keywords: MDR-TB management, RNTCP, field experience
Subjects: Tuberculosis > Clinical Research
Divisions: Clinical Research
Depositing User: Dr. Rathinasabapati R
Date Deposited: 31 Dec 2013 09:56
Last Modified: 09 Mar 2016 04:57

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