PLoS ONE (Jan 2011)

How do patients who fail first-line TB treatment but who are not placed on an MDR-TB regimen fare in South India?

  • Sharath Burugina Nagaraja,
  • Srinath Satyanarayana,
  • Sarabjit Singh Chadha,
  • Santosha Kalemane,
  • Jyoti Jaju,
  • Shanta Achanta,
  • Kishore Reddy,
  • Vishnu Potharaju,
  • Srinivas Rao Motta Shamrao,
  • Puneet Dewan,
  • Zachariah Rony,
  • Shailaja Tetali,
  • Raghupathi Anchala,
  • Nanda Kishore Kannuri,
  • Anthony David Harries,
  • Sachdeva Kuldeep Singh

DOI
https://doi.org/10.1371/journal.pone.0025698
Journal volume & issue
Vol. 6, no. 10
p. e25698

Abstract

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SETTING: Seven districts in Andhra Pradesh, South India. OBJECTIVES: To a) determine treatment outcomes of patients who fail first line anti-TB treatment and are not placed on an multi-drug resistant TB (MDR-TB) regimen, and b) relate the treatment outcomes to culture and drug susceptibility patterns (C&DST). DESIGN: Retrospective cohort study using routine programme data and Mycobacterium TB Culture C&DST between July 2008 and December 2009. RESULTS: There were 202 individuals given a re-treatment regimen and included in the study. Overall treatment outcomes were: 68 (34%) with treatment success, 84 (42%) failed, 36 (18%) died, 13 (6.5%) defaulted and 1 transferred out. Treatment success for category I and II failures was low at 37%. In those with positive cultures, 81 had pan-sensitive strains with 31 (38%) showing treatment success, while 61 had drug-resistance strains with 9 (15%) showing treatment success. In 58 patients with negative cultures, 28 (48%) showed treatment success. CONCLUSION: Treatment outcomes of patients who fail a first-line anti-TB treatment and who are not placed on an MDR-TB regimen are unacceptably poor. The worst outcomes are seen among category II failures and those with negative cultures or drug-resistance. There are important programmatic implications which need to be addressed.