Abstract
To study the profile of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) in tertiary care hospital setting, representing almost the whole affected population in Kashmir valley of India. A total of 910 cases of pulmonary tuberculosis were enrolled over four years. Among these, cases of MDR-TB and XDR-TB were meticulously studied for drug susceptibility, treatment, adverse effects profile and overall survival. Fifty-two (5.7%) cases of MDR-TB were identified, among which eight (15.3%) were diagnosed as XDR-TB on the basis of drug susceptibility testing, using the prescribed definition. The cases were sensitive to 2, 3, 4, 5 and more than 5 drugs in almost equal proportions. Thirty-seven (71.1%) cases were successfully cured; eleven (21.1%) patients died; and only four (7.6%) cases defaulted, indicating overall satisfactory adherence to treatment. For effective treatment of MDR-TB and XDR-TB, early case detection, improved laboratory facilities, availability of appropriate treatment regimens, and financial assistance in resource-limited settings through effective political intervention are necessary for better patient adherence and overall cure.
Highlights
Multidrug-resistant tuberculosis (MDR-TB), defined as resistance to at least isoniazid (H) and rifampicin (R), has become a significant public health problem worldwide and an obstacle to the effective global control of TB [1,2,3]
Data Collection Data was collected by analysis of the treatment cards of patients enrolled for directly observed treatment short-course (DOTS) at each visit to the hospital
Sputum culture and drug susceptibility testing were conducted in all such cases from the Dr Lal Path Labs, and SRL-Ranbaxy Laboratory, Delhi, by using the BACTEC MGIT960 instrument optimized for rapid detection of mycobacteria from the clinical specimens
Summary
Multidrug-resistant tuberculosis (MDR-TB), defined as resistance to at least isoniazid (H) and rifampicin (R), has become a significant public health problem worldwide and an obstacle to the effective global control of TB [1,2,3]. Per recent published reports from India, MDR-TB has been found in 3% of new and 12% of treated patients [2]. Other studies in India have shown that the rates of acquired drug resistance are invariably higher than the rates of primary drug resistance [4]; there are no published reports from the Jammu and Kashmir state so far. One report published in 2007 from Mumbai, India, observed 9-11% of MDRTB having XDR-TB cases, the expected figures would be higher, as there is lack of culture facilities [6]. To study the profile of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) in tertiary care hospital setting, representing almost the whole affected population in Kashmir valley of India. Cases of MDR-TB and XDR-TB were meticulously studied for drug susceptibility, treatment, adverse effects profile and overall survival. Conclusion: For effective treatment of MDR-TB and XDR-TB, early case detection, improved laboratory facilities, availability of appropriate treatment regimens, and financial assistance in resource-limited settings through effective political intervention are necessary for better patient adherence and overall cure
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