Document Type

Article

Department

Pulmonary and Critical Care

Abstract

INTRODUCTION: Community-based out-patient treatment for multidrug-resistant tuberculosis (MDR TB) is relatively new concept with reported successful outcomes.

OBJECTIVE: To assess the treatment outcomes of HIV negative multidrug-resistant tuberculosis (MDR TB) patients treated as outpatient at a tertiary care center in Karachi, Pakistan.

METHODS: A retrospective observational study of 53 consecutive, culture proven HIV negative MDR TB patients (resistant at least to both Isoniazid (H) and Rifampin(R) treated at Aga Khan University Hospital, Karachi between August 1999 and March 2007. Data were collected on predesigned performa regarding patient’s demography, clinical features, radiological findings, drug sensitivity, treatment and outcome.

RESULTS: A total of 53 HIV negative patients (27 males), with mean age of 37±15 years (range 15-76 years), received treatment as outpatient for culture proven MDR TB. 51 patients (96.2%) had pulmonary while 3 patients (5.6%) had extra-pulmonary TB. History of exposure to tuberculosis patients was found in 36 (67.9%) patients. Treatment regimen with 2nd line drugs was decided on individual basis according to DST on sputum culture results. The mean duration of treatment was 18 months. Successful outcome was seen in 25 patients (47.2%), 25 patients (47.2%) were loss to follow up and defaulted while 3 (5.6%) patients remain smear positive at the end of treatment. Success rate was 89 .2% in those who completed the treatment.

CONCLUSION: Community-based out-patient treatment strategy is both feasible and safe for the treatment of MDR-TB patients in resource limited country like Pakistan and this strategy should be integrated into the routine approach to treatment of MDR-TB patients in the country where the expertise are available. High default rate is this strategy is the main challenge which should be addressed.

Publication (Name of Journal)

Pakistan Journal of Chest Medicine

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