Pattern of initial drug resistance and its impact on short course chemotherapy of pulmonary tuberculosis

Abstract

Objectives : To find the pattern of initial drug resistance in fresh sputum culture positive cases of pulmonary tuberculosis and its impact on maintenance phase of short course chemotherapy (SCC) and treatment outcome. Methods : Case records of all patients of initial drug resistance treated by us be­tween Jan 2001 to May 2004 were analyzed retrospectively. Pattern of drug resis­tance leading to modification of maintenance phase of anti-tubercular treatment (ATT) and treatment out-come in these patients were analyzed. After treatment all cases were followed up for a minimum of six months duration, for relapse. Results : Out of 769 cases of culture positive pulmonary tuberculosis , drug resis­tance was seen in 138 patients. Out of total 203 individual drug resistance, resis­tance was present to isoniazid in 22, rifampicin in 27, ethambutol in 23, streptomy­cin in 16, pyrazinamide in 36 and ciprofloxacin in 79 cases. Among them 5 drugs resistance was seen in 4 patients, 4 drugs resistance in 3 patients, 3 drugs resistance in 9 patients, 2 drugs resistance in 22 patients and single drug resistance in 100 patients, Multi drug resistance (MDR) was observed in 12 patients. One patient died of hemoptysis after 4 months of ATT. Four patients continued to be sputum positive even after one year of second line ATT. They were subsequently lost to follow up. All the remaining patients achieved cure and had no relapse at the end of six months follow up. Conclusion: This study highlights the importance of initial drug resistance in modifying maintenance phase of short course chemotherapy, thereby improving success rates and helps in preventing multidrug resistance tuberculosis.