Arshad Javaid, Ziaullah, Anita Basit.
To study the outcome of patients with Multi-Drug Resistant Tuberculosis and see the effectiveness of second line drugs available in Pakistan in the management of MDR TB.
Pak J Chest Med Jan ;12(4):3-10.

Objective: MDR TB is a difficult problem to treat specially in countries like Pakistan, where facilities to treat the patients in hospital for the whole course of treatment are limited and also all the effective second line drugs are not available. This study was aimed to see the effectiveness of second line drugs that are available in Pakistan in terms of sputum conversion and cure rate and to see the resistance pattern of MDR TB. Place and Duration of Study: This study was carried out from 1st March 1995 to 31st Dec 2001 in a Chest Clinic in Peshawar. Subjects and Methods: All patients having active Pulmonary Tuberculosis with history of irregular treatment in past were included in the study irrespective of age and sex. Their sputum samples were sent for AFB culture and sensitivity and they were started on second line anti tuberculosis drugs. The pattern of drug resistance was noted from results of culture and sensitivity results, when available. The progress of the patient was monitored by clinical assessment, sputum examination and Chest Radiographs on subsequent follow up visits monthly for first three months and then at 2-3 months intervals until completion of treatment. Results: 70 patients, (40 males & 30 females) were included in the study. 05 patients excluded after their sputum C/S showed that they were not having MDR TB. 38% patients had bacilli resistant to all 06 first line drugs, 20% resistant to 05% drugs, 25% resistant to 04 drugs, 12% resistant to _3% drugs and only 05% were only resistant to 02 drugs i-e Rifampicin and INH. Regimen used was Kanamycin 15 mg/kg, Ofloxacin 400-800 mg/day, PAS 150 mg/kg, Ethionamide 15 mg/kg and Thiacetazone and INH 2.5 and 5 mg / kg respectively. The regimen was modified after C/S report with addition of first line drugs to which the bacilli were sensitive. Sputum Conversion: At the end of 02 months the conversion the conversion rate was 79%. Treatment Outcome: 55% patients were cured, 21% lost, 10% had treatment failure and 2% reported dead. Half of the patients cured have been attending for optional follow up for the period ranging from 1 to 6 years and only two patients have relapsed so for. Conclusion: The second line drugs that are available in Pakistan are effective both in terms of sputum conversion and achieving cure. Large number of patients lost signifies the fact that these patients need to be hospitalized and treated under direct supervision for the whole period of treatment as recommended.

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