Abstract
Introduction: Multidrug-resistant tuberculosis (MDR-TB) is a major public health problem in Africa and Asia. It is caused by a Koch bacillus (KB) resistant to at least isoniazid and rifampicin, the two most effective anti-TB drugs. His support is studded with several challenges including the frequency of side effects of second-line drugs and prolonged duration of treatment.
Aim: Determine predictors of treatment failure in MDR-TB.
Methods: Retrospective study (2009 – 2013) conducted in the two referral centers for care of MDR-TB in Tunisia. All the patients with confirmed MDR-TB were enrolled. Quantitative and qualitative variables were analyzed by SPSS17.0 software.
Results: Fifty-four cases of MDR-TB (mean age: 38 ± 13 years; sex ratio= 3.15) were collected. It was a primary MDR-TB in 17% of cases. All patients were treated according to WHO recommendations and one patient was operated at 9 months of TB treatment. Thirty-two patients were declared cured according to WHO criteria, 14 patients are being treated, five patients died and 3 patients had treatment failure. This treatment failure was correlated with a history of incarceration (n=2) (p <0.01) explained by the rebellious and unruly nature of the patient, with the isolated resistance to isoniazid and rifampicin (n=3) (p <0.05), the delay of negative cultures (n=3) (p <0.01), the absence of radiological improvement (n=1) (p <0.01) and therapeutic noncompliance (n=2) (p <0.01). However, this failure was not correlated with the secondary nature of multidrug resistance or the presence of adverse reactions to second-line drugs.
Conclusion: The cure of MDR-TB requires close collaboration between the patient and the physician, whose main pivot is DOTS.
- Copyright ©ERS 2015