مرکز منطقه ای اطلاع رساني علوم و فناوري - بررسي نتايج درمان در مبتلايان به بيماري نقش مقاومت دارويي و سازگاري با رژيم درماني در پاسخ به درمان در استان مازندران

چكيده لاتين :

Background & Aim : Recent studies have demonstrated high prevalence of multiple drug resistant mycobacterium tuberculosis. In this survey we assessed the treatemtn outcome of tuberculosis and the role of drug resistance and patients compliance in Mazandaran Province. Materials & Methods : In a prospective study during three years (2001-2003) 107 patients with a culture proven diagnosis of mycobacterium tuberculosis of sputum referring to Health Center of Province who underwent anti-tuberculosis medication were examined. Treatment outcome was classified as positive of negative based on the clinical assessment, improvement or detonation of chest X rays and the results of follow-up sputum examination. Patients were diveded to three groups based on treatment regimen compliance. The patients was regared as compliance when she or he completed the treatment without any interruption. Non compliance was registered when the treatment was interrupted for more than two weeks. Patients who were between these two groups were regarded as a poor compliance. Susceptibility testing was performed to isoniazed, nfampicin, etambutol and streptomycin by Agar dilution method. Multiple drug resistance was defined as a strain resistant to at least isoniazid and nfampicin. For data analysis chi square test was used and if data was less than 5, Fisherʹs exact test was performed. Analysis was carried out using the SPSS 11.0 software package and p<0.05 was defined statistically significant. Results: Ninethy five patients (51 men, 44 women, age range 18-85 years) completed the treatment. Of these, 69 patients (72.6%) showed positive results and 26(21.4%) were negative as the treatment outcome is concerned. However positive results is less (64.5%, 69/107) and negative result is higher (35.5%, 38/107) if patients who were lost to follow up are regarded as negative results. Multiple drug resistant Mycobacterium tuberculosis was observed in patients with negative results. The prevalence of poor compliance were found to be significantly higher in patients with negative treatment results compared to patients with positive results (p<0.0001). There was no significant difference in treatment outcome between the different age groups. Negative result was more common among males than among females patients, (20 patients, 39% and 6 patients, 13.6%, respectively, p=0.01). In this study, prevalence of poor compliance among males was significantly higher than females (37.2% and 11.4% respectively, p =0.03). Conclusion: In this survey, positive result of anti-tuberculosis treatment in Mazandaran province was below the rate recommended by WHO. This low rate was associated with poor compliance and drug resistant mycobacterium tuberculosis. These results emphasizes the importance of sensitivity tests for mycobacterium tuberculosis and close supervision of patients taking anti-tuberculosis medications.