OUTCOME OF CHEMOTHERAPY IN 107 PATIENTS WITH PULMONARY TUBERCULOSIS RESISTANT TO ISONIAZID AND RIFAMPIN

SETTING: National Masan Tuberculosis Hospital, Korea. OBJECTIVE: Treat ment for multidrug-resistant tuberculosis (MDR-TB) is considered to be clinically important, but there are few reports on this topic. We the refore retrospectively evaluated the outcomes of chemotherapy only for pulmonary MDR-TB. DESIGN: We reviewed the clinical courses of 107 pat ients with pulmonary disease due to Mycobacterium tuberculosis resista nt to rifampin and isoniazid who were under follow-up between March 19 96 and June 1996 after hospitalization between January 1993 and Januar y 1996. We performed a retrospective cohort study for all the patients ' records. Their regimens were selected individually and preferably in cluded four medications that they had not been given previously and to which the strain was fully susceptible. RESULTS: The 107 patients (me an age 38.3 years) had previously received a mean of five drugs, and w ere shedding bacilli that were resistant to a mean of four drugs. Of 6 3 patients with sufficient follow-up data, 52 (82.5%) responded to che motherapy (as indicated by negative sputum cultures for at least three consecutive months); 11 (17.5%) had no response, as shown by continua lly positive cultures. In a univariate analysis, an unfavorable respon se was significantly associated with resistance to a greater number of drugs before the current courses of treatment (relative risk 21.5; 95 % confidence interval 1.2-3.0; P < 0.05). The mean period of follow-up was 17 months. There was no subsequent relapse among the patients wit h responses, and there were no tuberculosis-related deaths. CONCLUSION : In this study, multidrug-resistant pulmonary tuberculosis responded relatively well to carefully selected regimens.