Authors: Singla, R.¹; Srinath, D.¹; Gupta, S.¹; Visalakshi, P.²; Khalid, U.K.³; Singla, N.³; Gupta, U.A.¹; Bharty, S.K.¹; Behera, D.¹

Source: The International Journal of Tuberculosis and Lung Disease, Volume 13, Number 4, April 2009 , pp. 521-526(6)

Publisher: International Union Against Tuberculosis and Lung Disease

Abstract:

SETTING: Tertiary level tuberculosis (TB) institute in Delhi, India.

OBJECTIVE: To study the risk factors for new pulmonary TB (PTB) patients failing treatment.

DESIGN: Prospective case-control study. The profile of new PTB patients failing treatment (i.e., sputum smear-positive at 5 months of treatment) and responders under the Revised National Tuberculosis Control Programme (RNTCP) were compared and risk factors associated with treatment failure were analysed.

RESULTS: A total of 42 treatment failure cases and 76 controls were enrolled in the study. The presence of cavity on chest X-ray (CXR), sputum acid-fast bacilli (AFB) smear positivity at 2 months of treatment and the number of interruptions in treatment were independently associated with failures. Among failure patients at 5 months, 17 (40.5%) had negative sputum culture for Mycobacterium tuberculosis, and only six (14.3%) had multidrug-resistant TB (MDR-TB). When put on retreatment, patients with smear-positive, culture-negative sputum had cure rates of 88.2% compared to 28.6% among culture-positive patients.

CONCLUSIONS: The presence of cavity on CXR, sputum smear positivity at 2 months of treatment and the number of interruptions of treatment are risk factors for failure. Among failures based on smear examination, the prevalence of MDR-TB is low and many patients have negative cultures for M. tuberculosis. Smear positivity at the end of treatment may not be a reliable indicator of treatment failure.

Keywords: tuberculosis; treatment failure; treatment outcome; risk factors

Document Type: Regular paper

Affiliations: 1: Department of Tuberculosis and Chest Diseases, Lala Ram Sarup Institute of Tuberculosis and Respiratory Diseases, New Delhi, India 2: Department of Microbiology, Lala Ram Sarup Institute of Tuberculosis and Respiratory Diseases, New Delhi, India 3: Department of Epidemiology, Lala Ram Sarup Institute of Tuberculosis and Respiratory Diseases, New Delhi, India

Publication date: 2009-04-01

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• The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

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