Management of multi drug resistance tuberculosis in the field: Tuberculosis Research Centre experience.
Management of multi drug resistance tuberculosis in the field: Tuberculosis Research Centre experience.
复制标题
现场多重耐药结核病的管理：结核病研究中心的经验。
DOI：
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发表时间：
2007
影响因子：
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通讯作者：
P. R. Narayanan
中科院分区：
文献类型：
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作者：
Aleyamma Thomas;R. Ramachandran;Fathima Rehaman;K. Jaggarajamma;T. Sántha;N. Selvakumar;N. Krishnan;N. S. Mohan;V. Sundaram;F. Wares;P. R. Narayanan
设置
从农村和城市地区发现的耐多药结核病（对异烟肼和利福平耐药）患者。
目的
研究在已实施DOTS计划的实地情况下管理耐多药结核病患者的可行性。
方法
在农村地区接受DOTS治疗的患者中以及在研究人群中疑似耐多药结核时从非政府组织转介的病例中确定的耐多药结核患者。在结核病研究中心（TRC）进行培养和药物敏感性测试。治疗方案根据个体情况决定。经过一段时间的初步住院治疗，继续在各自的外围保健设施或与非政府组织后，确定了现场DOT提供者的治疗。患者每月接受TRC的临床、社会学和细菌学评估。该月的药品已预先包装好，并移交给各中心。
结果
共有66例MDR TB患者（46例来自农村，20例来自非政府组织）从研究人群开始接受治疗，其中20例（30%）对一种或多种二线药物（Eto，Ofx，Km）耐药，包括一例“XDR TB”。不到一半的病人在医院呆了10天以上。治疗部分在监督下进行。提供注射被认为是一个主要问题。根据42例常规患者中40例的6个月涂片结果，可以正确预测治疗反应。仅在37%的病例中观察到成功的治疗结局，高默认率为24%。仅3例患者出现需要调整治疗的不良反应。
影响
尽管有可靠的DST和药物物流，主要挑战是通过确定一个更接近患者的提供者来维持患者的长期治疗，该提供者也可以进行注射，具有社交技能并管理轻微的不良反应。
SETTING
Multi-drug TB resistant (resistant to isoniazid and rifampicin) patients identified from a rural and urban area.
OBJECTIVE
To study the feasibility of managing MDR TB patients under field conditions where DOTS programme has been implemented.
METHODS
MDR TB Patients identified among patients treated under DOTS in the rural area and from cases referred by the NGO when MDR TB was suspected form the study population. Culture and drug susceptibility testing were done at Tuberculosis Research Centre (TRC). Treatment regimen was decided on individual basis. After a period of initial hospitalization, treatment was continued in the respective peripheral health facility or with the NGO after identifying a DOT provider in the field. Patients attended TRC at monthly intervals for clinical, sociological and bacteriological evaluations. Drugs for the month were pre-packed and handed over to the respective center.
RESULTS
A total of 66 MDR TB patients (46 from the rural and 20 from the NGO) started on treatment form the study population and among them 20 (30%) were resistant to one or more second line drugs (Eto, Ofx, Km) including a case of "XDR TB". Less than half the patients stayed in the hospital for more than 10 days. The treatment was provided partially under supervision. Providing injection was identified to be a major problem. Response to treatment could be correctly predicted based on the 6-month smear results in 40 of 42 regular patients. Successful treatment outcome was observed only in 37% of cases with a high default of 24%. Adverse reactions necessitating modification of treatment was required only for three patients.
IMPLICATIONS
Despite having reliable DST and drug logistics, the main challenge was to maintain patients on such prolonged treatment by identifying a provider closer to the patient who can also give injection, have social skills and manage of minor adverse reactions.