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