5 research outputs found
Short-course chemotherapy in neuro-tuberculosis - Brief review of clinical trials undertaken at the Tuberculosis Research Centre, Madras
Tuberculosis of the nervous system can present as tuberculous meningitis,
tuberculoma of brain, Potts paraplegia, tuberculosis of spine and rarely as arachnoiditis
and vasculitis.
Tuberculosis is conventionally treated for 12 to 18 months to ensure adequate cure,
stabilise quiescence and prevent relapses. With the introduction of rifampicin and
pyrazinamide it became feasible to shorten the duration of chemotherapy to 6 to 9
months. Many controlled clinical trials conducted all over the world have confirmed the
success of this approach in pulmonary tuberculosis by evolving 100% effective SCC
regimens 1-5. In a few studies especially tuberculous lymphadenitis, tuberculous abdomen
and pericarditis SCC has also been used and found to be as effective as conventional
regimens6,7. However, only recently has SCC been tried for neurotuberculosis. This
presentation briefly highlights some of the chemotherapy trials conducted at the
Tuberculosis Research Centre in some areas of CNS tuberculosis8-10.
What is SCC? SCC refers to chemotherapeutic regimens containing powerful
bactericidal drugs like INH, Rifampicin and Pyrazinamide, by the use of which the
duration of treatment of TB is reduced from the conventional 12 to 18 months to 6 to 9
months
A retrospective study of 'non-compliant' patients in controlled clinical trials of short course chemotherapy
In a total of 2,332 pulmonary
short-course chemotherapy studies conducted
during 1975-1985, there were 60 ‘noncompliant’
patients who had received less
than 75% of the prescribed treatment. A
retrospective study was undertaken to find
out the reasons for default in these patients
since the Tuberculosis Research Centre has
very stringent criteria of selection of patients
for their, studies, an adequate system. of
motivation of the patients and well organised
infrastructure for retrieval of the defaulters.
Unwillingness for treatment was stated
as the reason for default by 20 patients and
adverse reactions to the drugs by 16 patients.
Other major reasons given were pressure of
work (14 patients), frequent outstation visits
(13) and migration (12)
Increased yield of smear positive pulmonary TB cases by screening patients with >2 weeks cough, compared to >3 weeks and adequacy of 2 sputum smear examinations for diagnosis
Background
RNTCP recommends examining three sputum smears for AFB from Chest Symptomatics (CSs) with cough of >3 weeks
for diagnosis of Pulmonary TB (PTB). A previous multi-centric study from Tuberculosis Research centre (TRC) has
shown that the yield of sputum positive cases can be increased if duration of cough for screening was reduced to >2 weeks.
Other studies have shown that two smear examinations are adequate for diagnosis of smear positive PTB . To validate the
above findings, a cross sectional multi-centric study was repeated in different settings in five geographical areas in India.
Methods
Three primary and secondary level health facilities with high out-patient attendance were selected from two Tuberculosis
Units (TU) in each of the 15 selected districts to screen about 10,000 new adult outpatients from each state. For patients
who did not volunteer history of cough, symptoms were elicited using a structured simple questionnaire. All the CSs were
referred for sputum examination.
Results
A total of 96,787 out-patients were registered. Among them 69,209 (72%) were new adult out-patients. Using >2 weeks
of cough instead of > 3 weeks as the criterion for screening, there was an overall increase of 58% in CS and 23% increase
in the detection of smear-positive cases. Among 211 patients, 210 were positive at least by one smear from the initial
two specimens. Increase in the work-load if 2 smears were done for patients with cough of >2 weeks cough were 2
specimens (i.e.13 to 15) per day for an adult OPD of 150.
Conclusion
The yield of sputum positive PTB cases can be improved by screening patients with >2 weeks cough and two specimens
are adequate for diagnosis