How Do Patients Who Fail First-Line TB Treatment but Who Are Not Placed on an MDR-TB Regimen Fare in South India?

SETTING: Seven districts in Andhra Pradesh, South India. OBJECTIVES: To a) determine treatment outcomes of patients who fail first line anti-TB treatment and are not placed on an multi-drug resistant TB (MDR-TB) regimen, and b) relate the treatment outcomes to culture and drug susceptibility patterns (C&DST). DESIGN: Retrospective cohort study using routine programme data and Mycobacterium TB Culture C&DST between July 2008 and December 2009. RESULTS: There were 202 individuals given a re-treatment regimen and included in the study. Overall treatment outcomes were: 68 (34%) with treatment success, 84 (42%) failed, 36 (18%) died, 13 (6.5%) defaulted and 1 transferred out. Treatment success for category I and II failures was low at 37%. In those with positive cultures, 81 had pan-sensitive strains with 31 (38%) showing treatment success, while 61 had drug-resistance strains with 9 (15%) showing treatment success. In 58 patients with negative cultures, 28 (48%) showed treatment success. CONCLUSION: Treatment outcomes of patients who fail a first-line anti-TB treatment and who are not placed on an MDR-TB regimen are unacceptably poor. The worst outcomes are seen among category II failures and those with negative cultures or drug-resistance. There are important programmatic implications which need to be addressed

Treatment outcomes and drug susceptibility patterns for first line anti-TB drugs amongst Patients who failed Category I and Category II anti-TB treatment and who did not receive an MDR-TB treatment regimen in Andhra Pradesh, India (July 08 to December 09).

<p>*S-Streptomycin, H-Isoniazid, E-Ethambutol, NTM-Non tuberculosis mycobacterium;</p>#<p>Chi square test;</p>§<p>Fisher exact test.</p>$<p>(In order to calculate ‘<i>p value</i>’ treatment success is compared with other outcomes.</p

Treatment regimens and times of follow-up sputum smear examinations in the Indian Revised National Tuberculosis Control Programme.

<p>*In children, seriously ill sputum smear-negative Pulmonary Tuberculosis (PTB) includes all forms of sputum smear-negative PTB other than primary complex. Seriously ill extrapulmonary tuberculosis (EPTB) includes TB meningitis (TBM), disseminated TB, TB pericarditis, TB peritonitis and intestinal TB, bilateral extensive pleurisy, spinal TB with or without neurological complications, genitourinary TB, and bone and joint TB.</p><p>**Not seriously ill sputum smear-negative PTB includes primary complex. Not seriously ill EP-TB includes lymph node TB and unilateral pleural effusion.</p><p>***Prefix indicates month and subscript indicates thrice weekly.</p

Definitions of treatment outcome.

<p>Definitions of treatment outcome.</p

Treatment outcomes of TB patients who failed a first line anti-TB treatment and were not placed on MDR-TB treatment regimens, Andhra Pradesh, India (July 08 to December 09).

<p>*Chi-square test,</p><p>**Fisher exact test.</p>$<p>(In order to calculate ‘<i>p value</i>’ treatment success is compared with other outcomes).</p