Vel Kumar, G (2012) Outcome of Multi Drug Resistant Tuberculosis Patients started on dots Plus (CAT - IV RNTCP regimen) at Government Hospital of Thoracic Medicine, Tambaram Sanatorium. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION : The emergence of resistance to drugs used to treat tuberculosis (TB), and particularly Multidrug-resistant TB (MDR-TB), which is defined to resistance to atleast Isoniazid and Rifampicin with or without resistance to other drugs1, has become a significant health problem in a number of countries and an obstacle to effective TB control. Among all incident TB cases globally, 3.6% (95% CI: 3.0–4.4) are estimated to have MDR-TB. China and India account for almost 50% of the estimated global number of incident MDR-TB cases2. High MDR-TB mortality can be addressed through adequate prevention, diagnosis, treatment and care. Since the vast majority of cases are undetected and do not receive adequate care, we expect a global decline in MDR-TB mortality as the coverage and quality of DST and treatment programmes improve globally. Systematic infection control measures have the potential to greatly reduce transmission in hospitals and other congregate settings, and therefore the mortality of, HIV-associated MDR-TB. AIM OF THE STUDY : 1. To study the outcome of Multidrug-resistant tuberculosis (MDR-TB), patients 1 year after starting on DOTS PLUS (CAT IV RNTCP) enrolled from May 2009 to May 2010 at Government Hospital of Thoracic Medicine, Tambaram Sanatorium. 2. To analyze the factors associated with death and culture positivity at the end of one year. MATERIALS AND METHODS : STUDY DESIGN : Prospective study. INCLUSION CRITERIA : Culture proved 100 MDR-TB patients who were enrolled from May 2009 to May 2010 and initiated on DOTS PLUS therapy at GHTM is followed up for the period of one year. EXCLUSION CRITERIA : 1) Patients who are under 15 years of age, 2) History of more than 1 month treatment with any second line anti-TB drug. METHOD : Data’s were recorded from TB.HIV.Information.System (t.h.i.s).Follow up of patients were based on RNTCP DOTS PLUS guidelines. The clinical and microbiological outcome at the end of one year and factors associated with death and culture positivity were analyzed using multi variate analysis. RESULTS : Off the 100 patients analysed in our study who were started on treatment, 64% remained culture negative at the end of 1 year,15% died ,3% defaulted and 18% remain culture positive at the end of 1 year. CONCLUSION : Among 100 MDR-TB patients who were started on DOTS PLUS treatment in Tamilnadu, at the end of one year: • High mortality and culture positivity at the end of one year are found in patients who were <45 kgs. • Factors like Diabetes, Résistance to all first line drugs, Tobacco and Alcohol use and HIV does not have significant impact on outcome at the end of 1 year. • Major adverse events were rare and Adherence to treatment is good. • So it is very much essential to arrest the spread of resistant strains and to reduce the emergence of XDR-TB and help to decrease economic burden to the country in an indirect way. Timely identification of MDR-TB cases and adequately administered Category IV regimens are essential to stop primary transmission. DOTS/DOTS-Plus integration works synergistically to shut down all the potential sources of TB transmission. Global target -2015 : While information available is growing and more and more countries are taking measures to combat MDR-TB, urgent investments in infrastructure, diagnostics, and provision of care are essential if the target established for 2015 – the diagnosis and treatment of 80% of the estimated MDR/XDR-TB cases – is to be reached.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Multi Drug Resistant Tuberculosis Patients ; dots Plus ; CAT - IV RNTCP regimen ; Government Hospital of Thoracic Medicine ; Tambaram Sanatorium. |
| Subjects: | MEDICAL > Tuberculosis and Respiratory Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 28 Feb 2018 17:46 |
| Last Modified: | 28 Feb 2018 17:46 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/5920 |
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