D Nair1, B Velayutham1, T Kannan1, J P Tripathy2, A D Harries3,4, M Natrajan1, S Swaminathan5. 1. Department of Clinical Research, National Institute for Research in Tuberculosis, Chennai, India. 2. International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India. 3. The Union, Paris, France. 4. London School of Hygiene & Tropical Medicine, London, UK. 5. Indian Council of Medical Research, New Delhi, India.
Abstract
Setting: India has one of the highest global rates of multidrug-resistant tuberculosis (MDR-TB), which is associated with poor treatment outcomes. A better understanding of the risk factors for unfavourable outcomes is needed. Objectives: To describe 1) the demographic and clinical characteristics of MDR-TB patients registered in three states of India during 2009-2011, 2) treatment outcomes, and 3) factors associated with unfavourable outcomes. Design: A retrospective cohort study involving a record review of registered MDR-TB patients. Results: Of 788 patients, 68% were male, 70% were aged 15-44 years, 90% had failed previous anti-tuberculosis treatment or were retreatment smear-positive, 60% had a body mass index < 18.5 kg/m2 and 72% had additional resistance to streptomycin and/or ethambutol. The median time from sputum collection to the start of MDR-TB treatment was 128 days (IQR 103-173). Unfavourable outcomes occurred in 40% of the patients, mostly from death or loss to follow-up. Factors significantly associated with unfavourable outcomes included male sex, age ⩾ 45 years, being underweight and infection with the human immunodeficiency virus. Adverse drug reactions were reported in 24% of patients, with gastrointestinal disturbance, psychiatric morbidity and ototoxicity the most common. Conclusion: Long delays from sputum collection to treatment initiation using conventional methods, along with poor treatment outcomes, suggest the need to scale up rapid diagnostic tests and shorter regimens for MDR-TB.
Setting: India has one of the highest global rates of multidrug-resistant tuberculosis (MDR-TB), which is associated with poor treatment outcomes. A better understanding of the risk factors for unfavourable outcomes is needed. Objectives: To describe 1) the demographic and clinical characteristics of MDR-TBpatients registered in three states of India during 2009-2011, 2) treatment outcomes, and 3) factors associated with unfavourable outcomes. Design: A retrospective cohort study involving a record review of registered MDR-TBpatients. Results: Of 788 patients, 68% were male, 70% were aged 15-44 years, 90% had failed previous anti-tuberculosis treatment or were retreatment smear-positive, 60% had a body mass index < 18.5 kg/m2 and 72% had additional resistance to streptomycin and/or ethambutol. The median time from sputum collection to the start of MDR-TB treatment was 128 days (IQR 103-173). Unfavourable outcomes occurred in 40% of the patients, mostly from death or loss to follow-up. Factors significantly associated with unfavourable outcomes included male sex, age ⩾ 45 years, being underweight and infection with the human immunodeficiency virus. Adverse drug reactions were reported in 24% of patients, with gastrointestinal disturbance, psychiatric morbidity and ototoxicity the most common. Conclusion: Long delays from sputum collection to treatment initiation using conventional methods, along with poor treatment outcomes, suggest the need to scale up rapid diagnostic tests and shorter regimens for MDR-TB.
Authors: T Törün; G Güngör; I Ozmen; Y Bölükbaşi; E Maden; B Biçakçi; G Ataç; T Sevim; K Tahaoğlu Journal: Int J Tuberc Lung Dis Date: 2005-12 Impact factor: 2.373
Authors: Neel R Gandhi; N Sarita Shah; Jason R Andrews; Venanzio Vella; Anthony P Moll; Michelle Scott; Darren Weissman; Claudio Marra; Umesh G Lalloo; Gerald H Friedland Journal: Am J Respir Crit Care Med Date: 2009-10-15 Impact factor: 21.405
Authors: N Ahmad; A Javaid; A Basit; A K Afridi; M A Khan; I Ahmad; S A S Sulaiman; A H Khan Journal: Int J Tuberc Lung Dis Date: 2015-09 Impact factor: 2.373
Authors: Evan W Orenstein; Sanjay Basu; N Sarita Shah; Jason R Andrews; Gerald H Friedland; Anthony P Moll; Neel R Gandhi; Alison P Galvani Journal: Lancet Infect Dis Date: 2009-03 Impact factor: 25.071