Outcomes of Category III DOTS treatment in immunocompetent patients with tuberculosis pleural effusion
OBJECTIVES: To study the efficacy and safety of Category III DOTS treatment (intermittent thrice-weekly rifampicin [RMP], isoniazid [INH] and pyrazinamide for 2 months, followed by RMP and INH for 4 months) under India's Revised National Tuberculosis Control Programme in patients with
uncomplicated small unilateral pleural effusion (<1500 ml).
DESIGN: This prospective, multicentre, observational study recruited 351 patients between 2006 and 2010. Patients were regularly followed up clinically as well as with ultrasound examination of the chest.
outcome (clinical response with complete resolution on ultrasound examination at 6 months) was seen in 274 patients (78.1%). Efficacy was 88.9% (excluding defaulters), and 94% among those completing follow-up as per protocol. None of the patients received corticosteroids. Other outcomes included
treatment extension (n = 26, 7.4%), default (n = 43, 12.2%), treatment failure (n = 3, 0.9%) and death (n = 3, 0.9%). Seventy-nine mild/moderate adverse events and one treatment-related serious adverse event were noted; one patient developed recurrent drug-induced
hepatotoxicity. Two patients (0.7%) had relapse/re-infection at 24 months follow-up.
CONCLUSION: Intermittent thrice-weekly treatment for 6 months with three drugs in the intensive phase is effective and safe for unilateral small pleural effusion in immunocompetent patients. Although Category
III no longer exists in the programme, the results are reassuring for intermittent treatment in extra-pulmonary TB under programme conditions.
Document Type: Research Article
Department of Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
Department of Pulmonary Medicine, Sir Byramjee Jeejeebhoy Medical College, Ahmedabad, India
Department of Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
Department of Chest Diseases and Tuberculosis, Sawai Man Singh Medical College, Jaipur, India
National Centre for Disease Control, Ministry of Health and Family Welfare, Government of India, New Delhi, India
Publication date: November 1, 2012
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