Objective: To study the impact of anti-tuberculosis drug resistance on treatment outcome of pulmonary tuberculosis (TB) patients receiving directly observed treatment strategy (DOTS) in Henan Province, China.
Methods: From Aug. 2001 to Jun. 2002, the second round surveillance of anti-TB drug resistance was carried out in cooperation with WHO in Henan Province, China. The proportion method was used for drug susceptibility test and all enrolled patients were administrated with DOTS.
Results: The treatment success rate of smear-positive patients was 85.5% (1,343/1,571), of which the treatment success rate of initial-treatment cases was 89.6% (1,159/1,293). The treatment success rates among 565 anti-TB drug resistant cases and 215 multi-drug-resistant-TB (MDR-TB) cases were 76.6% (433/565), (initial treatment cases: 86.8%, 341/393; re-treated cases: 53.5%, 92/172; being significantly different), 58.6% (126/215), (initial treatment cases: 75.4%, 83/110; re-treated cases: 41.0%, 43/105; being significantly different), respectively. For the cases being resistant to 2, 3 or 4 drugs, the treatment success rates in initial treatment cases were all higher than those in re-treatment cases. Multivariate analysis showed that re-treatment, resistance to 2 plus drugs or MDR were the significant risk factors for treatment failure, and that re-treatment, older age and MDR were the significant risk factors for TB death.
Conclusion: The treatment outcome of initial treatment of smear-positive patients with DOTS in Henan was satisfying, but that of retreated patients, especially retreated patients of MDR was very poor. Re-treatment, older age, resistance to 2 anti-TB drugs or MDR were the risk factors for the poor outcome of treatment with DOTS.