Comparative Effectiveness of Tuberculosis Treatment Daily versus Intermittent Regimen in Indonesian TB-DM Patients: Real World Patient Database Study

Abstract

Background: diabetes mellitus (DM) increases the risk of active TB by three times; there is no specific treatment strategy for tuberculosis-DM (TB-DM) patients. The 2017 WHO guidelines no longer recommended an intermittent regimen in the advanced phase of TB treatment due to higher risk of failure, relapse, and drug resistance compared to the daily regimen. This study aims to compare the effectiveness of treatment, in terms of clinical response and sputum conversion, of TB-DM patients in the advanced phase between the two-treatment delivery schedules. Methods: a retrospective cohort study from the medical records of patients from 1 January 2015 to 31 December 2018 at Persahabatan Hospital, Jakarta. The inclusion criteria are TB-DM patients aged >18 years with non-reactive HIV test, who have entered the advanced phase of category 1 TB treatment with smear positive at the time of diagnosis. Results: a total of 72 patients met the inclusion criteria. (75% male and 88.8% had at least 1+ smear results at the time of diagnosis). Thirty subjects still have positive smear at the beginning of the advance phase of treatment. After the advanced phase, 44.2% in the intermittent and 41.4% in the daily group were curedhaving sputum conversion. Seven subjects had side effects; but there were lots of dropouts and it is unclear whether they dropped because of side effects or not. Conclusion:there is no difference between sputum conversion profile and treatment success in advanced phase TB-DM treatment category 1 between the daily and intermittent regimen.ly for diabetic patients.

Keywords

• tb-dm
• diabetes mellitus
• advanced phase
• intermittent treatment
• daily treatment
• treatment success