Role of Fluoroquinolones in Sputum Culture Conversion in MDR-TB Patients
Authors/Creators
- 1. RMO and Tutor, DTCD, DNB, Respiratory Medicine, Department of Chest Medicine, Institute of Post Graduate Medical Education and Research and SSKM Hospital, West Bengal, Kolkata
- 2. RMO and Tutor, MD, Respiratory Medicine, Department of Chest Medicine, Institute of Post Graduate Medical Education and Research and SSKM Hospital, West Bengal, Kolkata
Description
Background: Tuberculosis (TB) is an infectious disease caused by mycobacterium tuberculosis with a high incidence rate in India. In recent times, reducing the emergence of multi drug resistant TB (MDR-TB) poses a great challenge. Aims and objectives: To study the 3rd & 6th month sputum culture status, after starting Category IV regimen and factors responsible for culture conversion of MDR-TB patients. Material and Methods: We enrolled a total of 200 patients. Out of these, 3 patients were baseline XDR-TB, so excluded and 176 patients completed the study. All MDR/rifampicin resistant pulmonary TB patients >14 years of age receiving category IV regimen & willing to give consent for participation were included in the study. Patients with extrapulmonary TB were excluded. Majority of the patients (89.20%) patients remained negative at 3rd and 6th month. Results: We found a significant association between delayed culture conversion and former smokers with >20 pack year smoking history compared to early convertors with persistent culture negative at 6 months. At baseline, fluoroquinolone resistance was independently found to be significantly associated with adverse effect on culture conversion in the first 6 months. Also, there was significant association (p = 0.02) in patients showing culture positivity at 6th month following early negative cultures and current alcohol intake (within the last 6months) as well as with HIV positivity and cough > 2month. Female gender, conversion of sputum culture from positive to negative and radiological improvement was found to be positive predictors of a successful treatment outcome. While smoking habit and alcohol consumption was negative predictors of successful treatment outcome. Thirty five (26%) patients developed ADRs that required withdrawal of causal drug. Conclusion: This study presented with the various factors associated with early and delayed culture conversion and culture reversion of MDR-TB patients.
Abstract (English)
Background: Tuberculosis (TB) is an infectious disease caused by mycobacterium tuberculosis with a high incidence rate in India. In recent times, reducing the emergence of multi drug resistant TB (MDR-TB) poses a great challenge. Aims and objectives: To study the 3rd & 6th month sputum culture status, after starting Category IV regimen and factors responsible for culture conversion of MDR-TB patients. Material and Methods: We enrolled a total of 200 patients. Out of these, 3 patients were baseline XDR-TB, so excluded and 176 patients completed the study. All MDR/rifampicin resistant pulmonary TB patients >14 years of age receiving category IV regimen & willing to give consent for participation were included in the study. Patients with extrapulmonary TB were excluded. Majority of the patients (89.20%) patients remained negative at 3rd and 6th month. Results: We found a significant association between delayed culture conversion and former smokers with >20 pack year smoking history compared to early convertors with persistent culture negative at 6 months. At baseline, fluoroquinolone resistance was independently found to be significantly associated with adverse effect on culture conversion in the first 6 months. Also, there was significant association (p = 0.02) in patients showing culture positivity at 6th month following early negative cultures and current alcohol intake (within the last 6months) as well as with HIV positivity and cough > 2month. Female gender, conversion of sputum culture from positive to negative and radiological improvement was found to be positive predictors of a successful treatment outcome. While smoking habit and alcohol consumption was negative predictors of successful treatment outcome. Thirty five (26%) patients developed ADRs that required withdrawal of causal drug. Conclusion: This study presented with the various factors associated with early and delayed culture conversion and culture reversion of MDR-TB patients.
Files
IJPCR,Vol14,Issue6,Article19.pdf
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Additional details
Dates
- Accepted
-
2022-06-01
Software
- Repository URL
- https://impactfactor.org/PDF/IJPCR/14/IJPCR,Vol14,Issue6,Article19.pdf
- Development Status
- Active
References
- 1. Global Tuberculosis Report 2015: World Health Organization. Available from: http://www.booksamillion.com/p/G 2. National drug resistant survey - India; 2017 [yet to be published, personal communication from Dr. A. K. Bhatnagar] 3. RNTCP Guidelines on programmatic management of drug resistant TB (PMDT) in India – May 2012. Available from URL: http://tbcindia.nic.in/pdfs/Guidelines% 20for%20PMDT%20in%20India%20- %20May%202012.pdf 4. WHO The shorter MDR-TB regimen, 2016. Available from URL: http://www.who.int/tb/Short_MDR_re gimen_factsheet.pdf 5. Johnston JC, Shahidi NC, Sadatsafavi M, Fitzgerald JM. Treatment Outcomes of Multidrug-Resistant Tuberculosis: A Systematic Review and Meta-Analysis. PLoS ONE 4(9):e6914. Available from URL: https://doi.org/10.1371/journal.pone.00 06914 6. Gadallah MA, Mokhtar A, Rady M, ElMoghazy E, Fawzy M, Kandil SK. Prognostic factors of treatment among patients with multidrug-resistant tuberculosis in Egypt. Journal of the Formosan Medical Association. 2015 Dec 13. 7. Mzezewa, S. Z. The plight of women with cleft lips-A case report. Journal of Medical Research and Health Sciences, 2020:3(9), 1087–1089. 8. Jain K, Desai M, Solanki R, Dikshit RK. Treatment outcome of standardized regimen in patients with multidrug resistant tuberculosis. J Pharmacol Pharmacother. 2014 Apr;5 (2):145-49