Risk factors for new pulmonary tuberculosis patients failing treatment under the Revised National Tuberculosis Control Programme, 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.
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: April 1, 2009
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