Critical assessment of smear-positive pulmonary tuberculosis patients after chemotherapy under the district tuberculosis programme |
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| Affiliation: | 1. Centre for the Mathematical Modelling of Infectious Diseases and Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK;2. Medical Research Council Biostatistics Unit, Cambridge, UK;3. HIV and STI Department of Public Health England''s Centre for Infectious Disease Surveillance and Control, London, UK;4. Centre for Sexual Health and HIV Research, Department of Infection and Population Health, Mortimer Market Centre, University College London, London, UK;5. School of Health Sciences, City University London, London, UK;1. Department of Pulmonology, Amphia Hospital, Breda, The Netherlands;2. Department of Internal Medicine, Amphia Hospital, Breda, The Netherlands;3. Department of Pathology, Amphia Hospital, Breda, The Netherlands;4. Department of Pulmonology, Erasmus Medical Center, Rotterdam, The Netherlands;1. Peritoneal Surface Malignancy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori Milano, via Venezian 1, Milan, MI, CAP 20133, Italy;2. Department of Surgical Oncology, Jehangir Hospital, Sassoon Road, Pune, 411001, Maharashtra, India;3. Department of Gynecologic Oncology, National Cancer Institute of Mexico, Mexico city, CP14080, Mexico;4. Department of Surgical oncology, All India Insitute of medical sciences, Ansari Nagar, New Delhi, Delhi, 110029, India;5. Department of Surgery A, Tel-Aviv Sourasky Medical Center and Sackler Fcaulty of Medicine, Tel Aviv, Israel |
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| Abstract: | This is a status report of a retrospectively assembled cohort of 3357 smear-positive patients initiated on anti-tuberculosis chemotherapy in the North Arcot district between April 1986 and March 1988. The patients were contacted once at their homes between November 1988 and June 1989 (6 and 36 months after start of treatment), and information on their status, including death, could be obtained from 76% of them.Regimens were selected by the patients. 2306 (69%) had accepted short course regimens (SCC) and 1051 (31%) had been started on standard chemotherapy (non-SCC), 43% and 35% in SCC and non-SCC respectively had completed 80% or more of their treatment Overall mortality was 28%. Of those remaining, 31% had active disease and were excreting bacilli, among which 65% of the cultures were resistant to isoniazid and 12% to rifampicin. Combined resistance to isoniazid and rifampicin was seen in 4% and to isoniazid and streptomycin was seen in 19%.A significant finding was that even among those who had taken less than 50% of their treatment, 56% were bacteriologically negative. However, inadequate or irregular chemotherapy resulted in over four times the mortality and about twice the rate of smear positivity as compared with those taking adequate chemotherapy. No comparisons are made between patients on short-course and standard regimens as the patients selected their treatment and the groups are not comparable. |
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