Arshad Javaid, Ziaullah, Zafar Iqbal, Anila Basit, Faridullah Shah, Muhammad Yousaf Khan.
"DOTS plus in a tertiary care hospital of Peshawar NWFP"..
Pak J Chest Med Jan ;14(1):21-6.

Background: Treatment of patients with Multi drug resistance (MDR) Tuberculosis needs a prolonged treatment given under direct supervision. WHO recommends DOTS plus program for the treatment of such patients. Setting: Pulmonology Unit of Lady Reading Hospital was selected as a site for this pilot project of DOTS plus in North West Frontier Province (NWFP) Pakistan. Objective: The aim was to evaluate a teaching hospital settings for DOTS plus strategy and make it a model for the other centers in the province. Methods: Pulmonary Tuberculosis patients with culture proven MDR TB were enrolled in this study. The regimen used was Kanamycin, Ethionamide, Ofloxacin, Thiacetazone-INH, Para-amino Salicylic acid (PAS) for intensive phase of 2-3 months followed by continuation phase with Ethionamide, Ofloxacin, Thiacetazone-INH and PAS for at least 18 months after sputum conversion. Microbiological, Clinical and radiological progress was monitored at regular intervals. Results: This program was started in July 2005.and until June 2006, 100 patients (45 male and 55 Female) were registered. Nine patients were excluded as culture and sensitivity report of their sputum did not confirm MDR TB in them. Forty seven percent patients were below 30 years age & 40 % were between 30-49 years. Culture and Sensitivity results of 91 patients showed 7% resistance to Rifampicin plus INH (RH) only, 13% had RH plus one more drug resistance, 33% had RH plus two more drug resistance, and 36% had resistance to RH plus three more drugs, while 11% % of the isolates were resistant to all the six first-line anti TB drugs tested. Twenty eight (31%) patients have completed the treatment & have been followed for more than 2 years. Twenty nine patients were lost to follow up & 7 died during treatment. The rest of the patients are still on treatment & are being followed up; 19 of them (21%) have taken treatment for 18 months while 8 (9%) for 15 months. Seventy nine (87%) patients achieved sputum smear conversion within the first two months of treatment. Conclusion: The 2nd line drugs used for treatment of MDR TB are effective in terms of early sputum conversion and cure. High default rate signifies the need for hospitalization of these patients for a longer period. Regular supply of all the second line drugs is mandatory.

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