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Effectiveness of Shorter Treatment Regimen in Multidrug-Resistant Tuberculosis Patients in Pakistan: A Multicenter Retrospective Record Review

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  • 1 Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan;
  • 2 National Tuberculosis Control Program, Drug-Resistant TB, Islamabad, Pakistan;
  • 3 Department of Pulmonology, Bolan Medical College, Quetta, Pakistan;
  • 4 Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University Bahawalpur, Bahawalpur, Pakistan;
  • 5 Department of Pharmaceutics, Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan

ABSTRACT

In Pakistan, the treatment of multidrug-resistant tuberculosis (MDR-TB) with a shorter treatment regimen (STR), that is, 4–6 months of amikacin, moxifloxacin (Mfx), ethionamide, clofazimine (Cfz), pyrazinamide (Z), ethambutol (E), and high-dose isoniazid, followed by 5 months of Mfx, Cfz, Z, and E, was initiated in 2018. However, there is a lack of information about its effectiveness in Pakistani healthcare settings. Therefore, this retrospective record review of MDR-TB patients treated with STR at eight treatment sites in Pakistan aimed to fill this gap. Data were analyzed using SPSS 23. Multivariate binary logistic regression (MVBLR) analysis was conducted to find factors associated with death and treatment failure, and lost to follow-up (LTFU). A P-value < 0.05 was considered statistically significant. Of 912 MDR-TB patients enrolled at the study sites, only 313 (34.3%) eligible patients were treated with STR and included in the current study. Of them, a total of 250 (79.9%) were cured, 12 (3.8%) completed treated, 31 (9.9%) died, 16 (5.1%) were LTFU, and four (1.3%) were declared as treatment failures. The overall treatment success rate was 83.7%. In MVBLR analysis, patients’ age of 41–60 (odds ratio [OR] = 4.9, P-value = 0.020) and > 60 years (OR = 3.6, P-value = 0.035), being underweight (OR = 2.7, P-value = 0.042), and previous TB treatment (OR = 0.4, P-value = 0.042) had statistically significant association with death and treatment failure, whereas patients’ age of > 60 years (OR = 5.4, P-value = 0.040) and previous TB treatment (OR = 0.2, P-value = 0.008) had statistically significant association with LTFU. The treatment success rate of STR was encouraging. However, to further improve the treatment outcomes, special attention should be paid to the patients with identified risk factors.

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Author Notes

Address correspondence to Nafees Ahmad, Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Balochistan, Sariab Road, 87300 Quetta, Pakistan. E-mail: nafeesuob@gmail.com

Authors’ addresses: Abdul Wahid, Nafees Ahmad, and Fahad Saleem, Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan, E-mails: wahiduob@gmail.com, nafeesuob@gmail.com, and fahaduob@gmail.com. Abdul Ghafoor, National Tuberculosis Control Program, Drug-Resistant TB, Islamabad, Pakistan, E-mail: ghafoora177@gmail.com. Shereen Khan, Department of Pulmonology, Bolan Medical College, Quetta, Pakistan, E-mail: shereenqta@yahoo.com. Muhammad Atif, Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University Bahawalpur, Bahawalpur, Pakistan, E-mail: pharmacist_atif@yahoo.com. Qaiser Iqbal, Department of Pharmaceutics, Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan, E-mail: qasieruob@gmail.com.

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