Drug Resistance Profile among Post CAT II Sputum Positive Patients: Critical Analysis

Mohamed Shafiq, U (2007) Drug Resistance Profile among Post CAT II Sputum Positive Patients: Critical Analysis. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION : Since the first appearance of Tuberculosis in humans probably some 8000 years ago its control has continued to elude the brightest minds and to challenge both the human and economic resources of the countries around the world. Several authors have estimated the magnitude of the problems in the last two decades. All these publications represent estimates but they all indicate very clearly that Tuberculosis is still one of the major killer diseases in the world wide. It is estimated that one third of the worlds population (1.7 billion) are infected with Mycobacterium Tuberculosis. 1% of the worlds population are infected every year among these 95% of the affected individuals are in developing countries and 98% deaths due to Tuberculosis are also found to be in developing countries. These deaths accounts for 25% of all avoidable deaths in developing countries. Among the affected people 75 % are in the economically productive age. India has 28.4 % of entire world’s Tuberculosis burden. Every second one Indian above the age of 20 years is infected. There are about 14 million cases among which 3.5 million are sputum positive. Every year 2.2 Million people contact Tuberculosis. One Indian dies every minute which accounts for 5 lakhs per year. Estimates of prevalence of drug resistance in the community will be useful for formulating policies of the treatment with highly effective regiments to ensure cure and good drug compliance by patients and prevent emergence of drug resistance. Drug resistance Tuberculosis adds to the burden of illness in the community with the several constraints in the managements of patients. Highly efficacious treatment regimens utilizing drugs that have not been prescribed previously and known to possess good anti-mycobacterial activity need to be employed which could increase the operational costs in terms of drugs monitoring of toxicity to drugs and supervision of administration of drugs to ensure drug regularity. AIM OF THE STUDY : Evaluating drug resistance profile among patients reporting at institute of Thoracic Medicine Chennai with sputum positivity after taking cat II under RNTCP and either failed/relapsed or defaulted from category II. MATERIALS AND METHODS : 1. The study was conducted at Institute of Thoracic Medicine Chennai. 2. Patients who had reported with sputum positivity with the H/O treatment under RNTCP with cat II and subsequently failed/defaulted/relapsed were included in the study. 3. All of them were subjected to sputum AFB culture and sensitivity studies. 4. Sensitivity pattern were evaluated with their previous ATT prior to cat II. Total of 140 patients were included, 34 were excluded based on the exclusion criteria. The study conducted during 2004 & 2005. The remaining 106 patients were evaluated in this study. 5. It is a retrospective study cohort. The culture sensitivity obtained were analyzed retrospectively. INCLUSION CRITERIA : Patients who had reported with sputum positivity with history of treatment under RNTCP with Cat II and subsequently failed / defaulted / relapsed were included in the study. EXCLUSION CRITERIA : The following were the exclusion criteria; 24 1. Those who had diabetes mellitus (18 patients) at the time of enrollment into the study. 2. Those who had HIV positivity (6 patients) at the time of enrollment into the study. 3. Those patients whose AFB sputum cultures were contaminated (10 patients). CONCLUSION : The drug resistance profile among patients reporting Institute of Thoracic Medicine Chennai with sputum positivity after taking CAT II regimen under RNTCP and either failed / relapsed or defaulted from CAT II were evaluated and the following conclusions were made. 1. Possibility of MDR TB is found to be 87% when a patient fails with cat II under RNTCP. 2. Possibility of having MDR TB is to the tune of 90% when a patient fails with CAT II preceded by a failure in CAT I. 3. It is preferable to have culture and sensitivity study when the patient fails with cat I or atleast when the patient does not get converted at the end of intensive phase of cat II. By doing so unnecessary time delay in initiating appropriate reserve regimen can be avoided and can prevent the diseases transmission to others.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Drug Resistance Profile ; Post CAT II Sputum Positive patients ; Critical Analysis.
Subjects: MEDICAL > Tuberculosis and Respiratory Medicine
Depositing User: Subramani R
Date Deposited: 28 Feb 2018 16:10
Last Modified: 28 Feb 2018 16:10
URI: http://repository-tnmgrmu.ac.in/id/eprint/5904

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