RE-TREATMENT OUTCOME OF SMEAR POSITIVE TUBERCULOSIS CASES UNDER DOTS IN BANGALORE CITY

摘要

Summary : A cohort of 226 smear and culture positive re-treatment cases, initiated on Cat II regimen under DOTS, was followed up prospectively from April 1999 to September 2001, in Bangalore Mahanagara Palike to study the treatment outcome along with the drug susceptibility status. The cohort was interviewed at the initiation and end of treatment using a pre-tested semi-structured questionnaire to elicit details regarding past and present treatment. More than half of the study group (60%) were initially susceptible to all the regimen drugs. MDR -TB among the cohort was 12.8%. 'Treatment after default' cases constituted bulk of the cohort (65.5%) and 'defaults' among them were high.The overall favourable re-treatment outcome in the cohort was only 39.8% as a result of a high proportion of 'defaults' (43.8%). However, favourable outcome among those completing the prescribed duration of treatment was 75%, irrespective of pre-treatment drug susceptibility status. In addition, emergence of drug resistance, especially to Rifampicin, was negligible (1.8%) during current treatment despite the high default rate suggesting effectiveness of Cat II regimen. Favourable response among pre-treatment MDR cases was low (17.2%), and remained so even after excluding defaults, (22.7%) because the MDR component of the cohort was small.The study underscores the importance of treatment adherence for achieving success. The focus of treating the cohort should have been on prompt defaulter retrieval, especially of patients belonging initially to the type "treatment after default", who were potential defaulters. Besides, the low treatment efficiency in MDR cases makes it prudent to prevent development of MDR during primary treatment by strict adherence to DOTS, thereby making failed cases more amenable for re-treatment with Cat II regimen.