Effectiveness of DOTS regime in terms of cure, failure, default and relapse in the treatment of TB patients
DOI:
https://doi.org/10.18203/2349-3933.ijam20180079Keywords:
Continuation phase, Effectiveness, Intensive phaseAbstract
Background: DOTS has given very good results in terms of cure and satisfaction among tuberculosis patients. But still some failure and relapse cases occur. Hence studies on effectiveness of DOTS are required. The objectives of research were to study the effectiveness of DOTS regime in terms of cure, failure, default and relapse in the treatment of TB patients
Methods: A hospital based prospective follow up observational study was undertaken in the department of general medicine at a tertiary care medical college and hospital. The present study was conducted among the 60 eligible subjects as per the inclusion and exclusion criteria laid down for the present study.
Results: 41 were pulmonary cases and 19 were extra pulmonary patients. At the end of intensive phase only 7 cases were sputum positive out of 37 which reduced to three at the end of extended intensive phase of treatment which further reduced to two at the end of two months of continuation phase. But by the end of completion of continuation phase, one case again became sputum positive i.e. failure case making a final tally to three. It was seen that there was significant weight gain over the period of time in both pulmonary and extra pulmonary cases. The cure rate was 78%. One patient died. Two defaulted and three were failure cases.
Conclusions: The DOTS was found to be 78% effective in terms of cure rate. Still there is a huge gap of 22% found in the present scenario which needs to be addressed seriously and by all to prevent multi drug resistant tuberculosis.
References
Revised National Tuberculosis Control Programme for India. TB India: RNTCP Status Report. Central TB Division, Directorate General of Health Services, Ministry of Health and Family Welfare; 2001.
Hill AR, Manikal VM, Riska PF. Effectiveness of directly observed therapy (DOT) for tuberculosis: a review of multinational experience reported in 1990-2000. Medicine (Baltimore). 2002;81(3):179-93.
Azhar GS. DOTS for TB relapse in India: A systematic review. Lung India. 2012;29(2):147-53.
WHO. Global tuberculosis control, surveillance, planning, financing Geneva: WHO,2007. Available at http://apps.who.int/iris/handle/10665/43629.
Verver S, Warren RM, Beyers N, Richardson M, van der Spuy GD, Borgdorff MW, et al. Rate of reinfection tuberculosis after successful treatment is higher than rate of new tuberculosis. Am J Respir Crit Care Med. 2005;171(12):1430-5.
Dobler CC, Marks GB, Simposon SE, Crawford AB. Recurrence of tuberculosis at a Sydney chest clinic between 1994 and 2006: reactivation or reinfection? Med J. 2008;188(3):153-5.
du Plessis DG, Warren R, Richardson M, Joubert JJ, van Helden PD. Demonstration of reinfection and reactivation in HIV-negative autopsied cases of secondary tuberculosis: multilesional genotyping of Mycobacterium tuberculosis utilizing IS 6110 and other repetitive element-based DNA fingerprinting. Tuberculosis (Edinb). 2001;81(3):211-20.
Shamputa IC, Van Deun A, Salim MA, Hossain MA, Fissette K, de Rijk P, et al. Endogenous reactivation and true treatment failure as causes of recurrent tuberculosis in a high incidence setting with a low HIV infection. Trop Med Int Heal. 2007;12(6):700-8.
Garcia de Viedma D, Marin M, Hernangomez S, Diaz M, Ruiz Serrano MJ, Alcala L, et al. Tuberculosis recurrences: reinfection plays a role in a population whose clinical/epidemiological characteristics do not favor reinfection. Arch Intern Med. 2002;162(16):1873-9.
Kliiman K, Altraja A. Predictors and mortality associated with treatment default in pulmonary tuberculosis. Int J Tuber Lung Dis. 2010;14(4):454-63.
Blondal K, Viiklepp P, Guomundsson LJ, Altraja A. Predictors of recurrence of multidrug-resistant and extensively drug-resistant tuberculosis. Int J Tuber Lung Dis. 2012;16(9):1228-33.
Holtz TH, Sternberg M, Kammerer S, Laserson KF, Riekstina V, Zarovska E, et al. Time to sputum culture conversion in multidrug-resistant tuberculosis: predictors and relationship to treatment outcome. Ann Intern Med. 2006;144(9):650-9.
