Singh Abhijeet, Prasad Rajendra, Kushwaha Ram Awadh Singh, Srivastava Rahul, Giridhar Belur Hosmane, Balasubramanian Viswesvaran, Jain Amita
Department of Pulmonary Medicine, King George Medical College, Lucknow, Uttar Pradesh, India.
Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India.
Lung India. 2019 Sep-Oct;36(5):384-392. doi: 10.4103/lungindia.lungindia_475_18.
Multidrug-resistant tuberculosis (MDR-TB) is a global health problem with notoriously difficult and challenging treatment. This study determined treatment outcome in patients of MDR-TB with modified DOTS-Plus strategy.
Ninety-eight consecutive MDR-TB patients treated with standardized regimen according to modified DOTS-Plus strategy aligned to the existing national DOTS-Plus guidelines with relevant modifications proposed by Chennai consensus were analyzed prospectively. Treatment included monthly follow-up with clinical, radiological, and bacteriological assessment (sputum smear advised monthly till conversion then quarterly; culture for Mycobacterium tuberculosis at 0, 4, 6, 12, 18, and 24 months), ensuring adherence, intense health education, and monitoring of adverse events (AEs). Patients' outcome was considered as cure when at least two of the last three cultures (all three or last two) were negative and as failure when the same were positive.
Favorable and unfavorable outcomes in this cohort were reported to be 71/98 (72.4%) and 27/98 (27.6%) (failure - 10 [10.2%], default - 7 [7.1%], and expiry - 10 [10.2%]), respectively. Sputum smear and culture conversion rate were 75/81 (92.5%) and 71/81 (87.7%), respectively. Major AEs were experienced in only 17.4% of patients.
MDR-TB can be cured successfully with modified DOTS-Plus strategy and requires much effort from both the patients and health-care workers. It can be an alternative model for treating MDR-TB patients in private sector.
耐多药结核病（MDR-TB）是一个全球性的健康问题，其治疗 notoriously difficult（极其困难）且具有挑战性。本研究确定了采用改良的直接观察短程治疗强化策略（DOTS-Plus）治疗耐多药结核病患者的治疗结果。
前瞻性分析了98例连续的耐多药结核病患者，这些患者根据改良的DOTS-Plus策略接受标准化治疗方案，该策略与现有的国家DOTS-Plus指南一致，并采用了钦奈共识提出的相关修改建议。治疗包括每月进行临床、影像学和细菌学评估随访（建议每月进行痰涂片检查直至转阴，然后每季度进行一次；在0、4、6、12、18和24个月进行结核分枝杆菌培养），确保依从性，加强健康教育，并监测不良事件（AE）。当最后三次培养中的至少两次（全部三次或最后两次）为阴性时，患者的结果被视为治愈；当结果为阳性时，则视为治疗失败。
该队列中良好和不良结果分别报告为71/98（72.4%）和27/98（27.6%）（治疗失败 - 10例[10.2%]，失访 - 7例[7.1%]，死亡 - 10例[10.2%]）。痰涂片转阴率和培养转阴率分别为75/81（92.5%）和71/81（87.7%）。只有17.4%的患者经历了主要不良事件。
采用改良的DOTS-Plus策略可以成功治愈耐多药结核病，这需要患者和医护人员付出很大努力。它可以成为私营部门治疗耐多药结核病患者的一种替代模式。
