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Tuberculosis
Treatment outcomes of patients with MDR-TB in Nepal on a current programmatic standardised regimen: retrospective single-centre study
  1. Samiksha Ghimire1,
  2. Samriddhi Karki2,
  3. Bhagwan Maharjan2,
  4. Jos G W Kosterink1,
  5. Daan J Touw1,3,
  6. Tjip S van der Werf4,
  7. Bhabana Shrestha2 and
  8. Jan-Willem Alffenaar1,5
  1. 1Clinical Pharmacy and Pharmacology, University of Groningen Faculty of Medical Sciences, Groningen, The Netherlands
  2. 2Tuberculosis Unit, Nepal Anti-Tuberculosis Association/German Nepal TB Project, Kathmandu, Nepal
  3. 3Groningen Research Institute of Pharmacy, Department of Pharmaceutical Analysis, University of Groningen, Groningen, Groningen, the Netherlands
  4. 4Infectious Diseases Service and Tuberculosis Unit, University of Groningen Faculty of Medical Sciences, Groningen, The Netherlands
  5. 5Faculty of Medicine and Health, School of Pharmacy and Westmead hospital, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Samiksha Ghimire; s.ghimire{at}umcg.nl

Abstract

Objectives The objectives of this study were to evaluate treatment in patients on current programmatic multidrug-resistant tuberculosis (MDR-TB) regimen and verify eligibility for the 9-month regimen and therapeutic drug monitoring (TDM).

Methods We performed a retrospective chart review of patients with MDR-TB receiving standardised regimen at the German Nepal TB Project Clinic, Nepal, between 2014 and 2016. Eligibility for the 9-month regimen and indications for TDM were evaluated.

Results Out of 107 available patients’ medical records, 98 were included. In this centre, the MDR-TB treatment success rates were 69.0% in 2015, 86.6% in 2016 and 86.5% in 2017. The median time to sputum smear conversion was 60 days (60–90 IQR) and culture conversion was 60 days (60–90 IQR). Observed side effects did not impact treatment outcomes. No difference in treatment success rates was observed between patients with predisposing risk factors and those without. Only 49% (36/74) of patients were eligible for the 9-month regimen and 23 patients for TDM according to American Thoracic Society guideline criteria.

Conclusions Nepalese patients with MDR-TB on ambulatory care had good treatment outcome after programmatic treatment. Implementation of the new WHO oral MDR-TB treatment regimen may further improve treatment results. The 9-month regimen and TDM should be considered as part of programmatic care.

  • tuberculosis
  • respiratory infection
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjresp-2020-000606

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    Footnotes

    • Contributors SG, JGWA, TSvdW and DJT conceptualised and designed the study and iteratively revised the manuscript. SG and SK performed data collection and analysis. SG drafted the manuscript and all authors provided detailed feedback and approved the final manuscript.

    • Funding This study was funded by the Department of Clinical Pharmacy and Pharmacology of University Medical Center Groningen, University of Groningen, the Netherlands. In addition, the authors acknowledge Eric Bleumink Fund of University of Groningen for providing academic support to Samiksha Ghimire.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The study was approved by the Ethical Review Board of Nepal Health Research Council, Kathmandu, Nepal (No. 283/2018).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request and will be provided by the corresponding author of this manuscript.