1658. Satisfactory Outcomes in Children with Multidrug Resistant (MDR) Tuberculosis (TB) in Mumbai with Individualized Susceptibility Based Treatment
Session: Poster Abstract Session: Mycobacterial Infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Poster Presenter_1.jpg (1.8 MB)
  • Background:

    Mumbai is a hot spot for MDR TB with prevalence rates of 3% in new and 17% in previously treated adult cases. Increasing incidence of extreme drug resistance (XDR) and even total drug resistance (TDR) in adults has been reported. There is no published data on susceptibility pattern and clinical outcomes of children with MDR TB from Mumbai or India.

     Methods:

    A retrospective chart review of children < 18 years presenting to a private tertiary care hospital over the past 3 years with suspected MDR TB was conducted. Children with proven MDR TB on basis of drug susceptibility testing by MGIT or Hain MTBDRplus assay were included. Demographic details, time to diagnosis, site of disease, drug susceptibility pattern, treatment details, response and duration of therapy were extracted and summarized.

    Results:

    Twenty children with suspected MDR TB presented to the centre; diagnosis was confirmed in 14. Of these 14, 12 were girls, median age was 13.5 years (range 3-18). The disease was only pulmonary in 6, pulmonary and node in 5, only lymph nodes in 2 and CNS in 1. None of these patients had a known adult MDR TB contact. The median time to diagnosis was 12 months. Resistance to ofloxacin and streptomycin was noted in 80%, ethionamide and moxifloxacin in 72%, pyrazinamide and ethambutol in 60%, para amino salicyclic acid (PAS) in 9%, 2ndline aminoglycosides and clofazimine in 0%. Initial empirical therapy was modified on basis of susceptibility and a median of 6 drugs were used. Kanamycin was used in 100% (6 months), cycloserine in 90%, PAS in 77% and Moxi in 40%. Linezolid, clofazimine were used in 50%. Ethionamide was the least  tolerated. At present 10 children have completed 18 months therapy and are in sustained remission, 3 patients are in clinical remission with negative cultures and only 1 patient has progressive lung disease despite 12 months therapy.

    Conclusion:

    Clinical success was noted in 13/14 children and cure in 10. Though there were no XDR cases, high prevalence of resistance was noted to newer quinolones and ethionamide. These drugs are the backbone of empirical regimes suggested by the revised national tuberculosis control program (RNTCP) of India. The study suggests that individual treatment based on susceptibility results is the way forward and there is need to relook at the component drugs of empirical regimes.

    Tanu Singhal, MD, Infectious Disease and Pediatrics, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India, Camilla Rodrigues, Microbiology, PD Hinduja Hospital, Mumbai, India, Rajeev Soman, MD, Internal Medicine, PD Hinduja Hospital, Mumbai, India and Sweta Shah, MD Microbiology, Microbiology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, mumbai, India

    Disclosures:

    T. Singhal, None

    C. Rodrigues, None

    R. Soman, None

    S. Shah, None

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