Treatment Outcomes of New and Previously-Treated
Smear Positive Pulmonary Tuberculosis at Srinagarind
Hospital, a Tertiary Care Center in Northeast Thailand
Wipa Reechaipichitkul MD*,
Apichart So-ngern MD*, Prajuab Chaimanee MSc**
Affiliation :
* Division of Pulmonary and Critical Care, Department of Medicine, Faculty of Medicine,
Khon Kaen University, Khon Kaen, Thailand
** Clinical Microbiology Unit, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
Objective : To study treatment outcomes of new and previously-treated smear positive pulmonary TB according to current
WHO guideline 2010 and factors related to treatment success at Srinagarind Hospital.
Material and Method: Adult patients who had smear-positive pulmonary TB treated at Srinagarind Hospital between
January 2005 and December 2010 were enrolled in the present study.
Results : Over a 6-years period, 322 patients (272 new and 50 previously-treated cases) were diagnosed smear positive
pulmonary TB. The mean age was 48.85 (SD 17.9) years and the male to female ratio was 1.8:1. The mean duration of
symptoms in the previously-treated group was longer than the new cases (2.39 vs. 1.99 months, p = 0.38). Symptoms,
underlying diseases, HIV status, and organ involvement between these two groups were not different. Two-thirds (72.1% of
patients) had cough, 35.4% had fever, and 20.5% weight loss. Twenty-three percent of cases had underlying DM and 7.8%
were HIV positive. Disseminated TB was found in 18.9% of cases. The mean duration of treatment in new cases was 6.88
months vs. 11.20 months in previously-treated cases. The common regimens for new cases included 2IRZE/4IR (72.8%) and
2IRE/7IR (19.1%) vs. 2IRZE/4IR (62%), 2IRE/7IR (12%), and other regimens for MDR patients (6%) among the previously-
treated cases. However in previously-treated group IRZES/IRZE/IRE (p = 0.001), second-line drugs (p = 0.002), and MDR
regimens (p<0.001) were statistically more common treatments than in the new cases group. About 60% of cases were
treated at TB clinic. The success rate among new cases who had completed treatment at Srinagarind Hospital was higher
than for previously-treated ones (94.8% vs. 86.4%; p = 0.04). Among previously-treated cases (n = 50); 24 were defaulters,
19 were relapses, and seven were failures. For the defaulted and relapsed cases, patients usually received the IRZE/IR or
IRZES/IRZE/IRE regimens. On the other hand, for failure cases, patients usually received the second-line drugs or MDR
regimens. The overall success rate in defaulted cases was 87.6%, vs. 68.4% who relapsed and 57.1% who failed (p = 0.067).
For new cases, the isolations found DR-TB 3.6% and MDR-TB 0%. For previously-treated cases, the isolations found
DR-TB 16.67% and MDR-TB 6.25%. The only one factor related to successful outcomes was treatment at TB clinic (adjusted
OR 2.01, 95% CI 1.18-3.43).
Conclusion : Previously-treated pulmonary TB had less success rate than new cases. Culture and susceptibility for previously-
treated group were recommended before starting treatment. Treatment at TB clinic improved treatment outcomes.
Keywords : Pulmonary TB, Treatment outcomes, Factors related to success
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