Multi-Drug Resistant Pulmonary Tuberculosis

Multidrug resistant tuberculosis (MDR TB) is defined as resistance to isoniazid and rifampicin. The recent Global Project on drug-resistant TB confirmed that multidrug-resistant TB was found in all regions of the world. Misdiagnosis of MDR tuberculosis due to laboratory related errors has been reported recently and hence susceptibility results alone should not dictate treatment and careful clinical correlation is necessary. Drug-susceptible TB can be cured in six to eight months with first-line anti-TB drugs. However, incorrect or partial treatment results in drug-resistant TB. WHO has recommended that multidrug resistant tuberculosis should be considered after failure of fully supervised category II or I treatment regimen. In a retrospective study of 55 cases of MDR pulmonary TB referred to our centre treated with kanamycin, ethionamide, cycloserine and PAS (KCEP) +/- quinolones, 38 (69.09%) patients completed treatment, 11 defaulted and 6 died. 31/38 (81.57%) cases were cured and 7/38 (18.4%) failed on therapy. All cases that failed had received one or more second line drugs previously. The cost of treatment ranged from $1000 to $3000. Adverse drug effects were seen in 8/55 patients (14.54%). Second line drugs for tuberculosis have been now listed under the WHO essential drugs list and are available through the Green Light Committee. Adherence to the strict guidelines will result in proper management of existing cases of MDRTB.