Outcomes of individualised treatment for multidrug-resistant tuberculosis before DOTS-plus

Abstract

Setting: A tuberculosis (TB) out-patient service in the city of Santa Cruz, Bolivia.

Objective: To evaluate the outcomes of patients with TB resistant to isoniazid and rifampicin (multidrug resistance [MDR]) treated in a resource-poor area before the introduction of the DOTS-Plus initiative.

Design: Retrospective cohort study of MDR-TB patients treated with individualised regimens between January 1983 and December 1993.

Results: Among 143 patients studied, 73 (51%) were males; the mean age was 33.9 years. Forty (28%) were new patients and 103 (72%) were previously treated patients. The treatment regimen had to be modified in 122 (85%) patients. A successful outcome was achieved in 41 (28%) patients; 68 (48%) defaulted, 18 (13%) died, and 14 (10%) were still under treatment in 1996.

Conclusions: The treatment approach described had dismal results. The capacity for performing drug susceptibility testing and the availability of several second-line anti-tuberculosis drugs were not sufficient to achieve cure in more than one third of the patients treated. Other factors, such as a set of standard procedures, clear guidelines for the treatment and follow-up of patients and the administration of directly observed treatment, must be included in a programme for treating MDR-TB, to obtain better treatment results.