A COMPARISON OF DRUG RESISTANCE PATTERN IN CATEGORY-I FAILURE VERSUS CATEGORY-I RELAPSE PULMONARY TB PATIENTS ATTENDING A TERTIARY CARE HOSPITAL IN SOUTH PUNJAB, PAKISTAN. IS WHO CATEGORY-II ATT REGIMEN APPROPRIATE?

MI Shahzad, S Ayyaz, GM Humayun, MH Kamran, LA Dogar, AA Shaheen, AA Kazmi, A Hafeez, MZ Saheen

Abstract


Introduction: There are emerging reports of increasing number of patients with drug resistant tuberculosis in WHO category-ll patients (Category-l failure and Category-l relapse groups). Therefore, current WHO recommendation for the treatment of Category-ll patients may not be the best option. We conducted a prospective study in which drugs sensitivity pattern in patients in Category-l failure and relapse were performed at the start of treatment and compared.
Setting: The study was done in the chest clinic of a tertiary care hospital (Nishtar Medical Institution Multan, South Punjab) and an attached DOTS TB center. MTB cultures and DST was done at Aga Khan University Hospital TB laboratory at Karachi which is an accredited reference laboratory for this test.
Objective: To determine the pattern of drug resistance in category-I failure and relapse pulmonary TB patients and also to see if the currently recommended WHO Category-II regimen is appropriate for these two groups. Design: This was a prospective, analytic study. A total of 88 pulmonary tuberculosis patients who had taken anti-tuberculosis treatment were evaluated prospectively with respect to their drug resistance pattern by sputum culture for acid-fast bacilli (AFB) and sensitivity testing with first line drugs (FLD) as well as second line drugs (SLD).
Results: A total of 88 patients were found to be evaluable; 33 (37%) were Cat-I failure and 55(63%) were Cat-I relapse. Among 33 Patients in Cat-1 failure group, 13 had taken DOTS treatment and 20 received Non-DOTS treatment. Four (12%) cases were XDR-TB, 16 (48%) were MDR-TB, 5 (15%) were Poly resistant TB, 4 (12%) were Mono resistant and 4(12%) were sensitive to all drugs. A higher percentage, 65% (13/20 cases) of MDR/XDR-TB was found in Non-DOTS group as compared to DOTS group, 35 %.( 7/20 cases). Among 55 Patients in Cat-I relapse, 33 had taken DOTS treatment and 22 received Non-DOTS treatment (p=0,001) Four (7%) cases were XDR-TB, 20 (36%) were MDR-TB, 3 (5%) were Mono resistant, 3 (5%) were Poly resistant and 25 (45%) were sensitive to all drugs. A higher percentage, 55% (13/24 cases) of MDR/XDR-TB was found in DOTS group as compared to Non-DOTS group 45% i.e. 11/24 cases (p=0.006).
Conclusion: Our results suggest an urgent need to revise our management strategies for both Category-I failure and relapse patients. Early TB culture and drug sensitivity should be performed on these patients in order to avoid spread of MDR-TB and its associated morbidity and mortality, by choosing correct regimen on the basis of DST results performed in the beginning.


Keywords


Multi drugs resistant tuberculosis; acquired drug resistant; extensively drug resistant tuberculosis; Pakistan, WHO TB guidelines, TB relapse.

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