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Ambulatory-Based Standardized Therapy for Multi-Drug Resistant Tuberculosis: Experience from Nepal, 2005–2006

Author

Listed:
  • Pushpa Malla
  • Elisabeth Eva Kanitz
  • Mohammad Akhtar
  • Dennis Falzon
  • Knut Feldmann
  • Christian Gunneberg
  • Shyam Sundar Jha
  • Bhagwan Maharjan
  • Mohan Kumar Prasai
  • Bhabana Shrestha
  • Sharat Chandra Verma
  • Matteo Zignol

Abstract

Objective: The aim of this study was to describe treatment outcomes for multi-drug resistant tuberculosis (MDR-TB) outpatients on a standardized regimen in Nepal. Methodology: Data on pulmonary MDR-TB patients enrolled for treatment in the Green Light Committee-approved National Programme between 15 September 2005 and 15 September 2006 were studied. Standardized regimen was used (8Z-Km-Ofx-Eto-Cs/16Z-Ofx-Eto-Cs) for a maximum of 32 months and follow-up was by smear and culture. Drug susceptibility testing (DST) results were not used to modify the treatment regimen. MDR-TB therapy was delivered in outpatient facilities for the whole course of treatment. Multivariable analysis was used to explain bacteriological cure as a function of sex, age, initial body weight, history of previous treatment and the region of report. Principal Findings: In the first 12-months, 175 laboratory-confirmed MDR-TB cases (62% males) had outcomes reported. Most cases had failed a Category 2 first-line regimen (87%) or a Category 1 regimen (6%), 2% were previously untreated contacts of MDR-TB cases and 5% were unspecified. Cure was reported among 70% of patients (range 38%–93% by Region), 8% died, 5% failed treatment, and 17% defaulted. Unfavorable outcomes were not correlated to the number of resistant drugs at baseline DST. Cases who died had a lower mean body weight than those surviving (40.3 kg vs 47.2 kg, p

Suggested Citation

  • Pushpa Malla & Elisabeth Eva Kanitz & Mohammad Akhtar & Dennis Falzon & Knut Feldmann & Christian Gunneberg & Shyam Sundar Jha & Bhagwan Maharjan & Mohan Kumar Prasai & Bhabana Shrestha & Sharat Chand, 2009. "Ambulatory-Based Standardized Therapy for Multi-Drug Resistant Tuberculosis: Experience from Nepal, 2005–2006," PLOS ONE, Public Library of Science, vol. 4(12), pages 1-8, December.
    • Handle: RePEc:plo:pone00:0008313
    DOI: 10.1371/journal.pone.0008313
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    References listed on IDEAS

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    1. Shin, Sonya & Furin, Jennifer & Bayona, Jaime & Mate, Kedar & Kim, Jim Yong & Farmer, Paul, 2004. "Community-based treatment of multidrug-resistant tuberculosis in Lima, Peru: 7 years of experience," Social Science & Medicine, Elsevier, vol. 59(7), pages 1529-1539, October.
    2. Lönnroth, Knut & Jaramillo, Ernesto & Williams, Brian G. & Dye, Christopher & Raviglione, Mario, 2009. "Drivers of tuberculosis epidemics: The role of risk factors and social determinants," Social Science & Medicine, Elsevier, vol. 68(12), pages 2240-2246, June.
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