Multiple drug resistant tuberculosis in South London

The outcome of Multiple Drug Resistant Tuberculosis (MDR-TB) has generally been poor. Management of MDR-TB was assessed in Lambeth, Southwark and Lewisham Health Authority between Jan 1995 and Jan 1999. HIV tests were not routinely performed and known HIV positive cases have been excluded from this study. RESULTS: 796 patients were notified as Tuberculosis, 12 having MDR-TB (1.5%). MDR-TB cases had a median age of 29 years (range 15-53). All had pulmonary disease except two (chest-wall, hip-joint). The countries of origin were: UK, 5 cases: Somalia 2; Sierra Leone 2, Viet Nam, Ghana, Portugal 1 each. Risk factors were: Past TB treatment (6 cases, 3 known inadequate): Poor compliance (5): Drug and/or alcohol abuse (2). Five were known to be HIV negative, others were not HIV tested. Four patients were well on treatment; one (known HIV negative) died following treatment failure. FOLLOW UP GROUP: Seven patients were followed up for at least 2 years (range 2-5) after the end of treatment. They had organisms resistant to a median of 3 drugs (range 2-4): Rifampicin and Isoniazid (all), Streptomycin (5 cases), Pyrazinamide (1), Ciprofloxacin (1), PAS (1). The median number of drugs used after diagnosis of MDR-TB was 3 (range 2-4); drugs used included Streptomycin, Pyrazinamide, Ethambutol, Ciprofloxacin, Ofloxacin, Clarithromycin, Clofazimine, Prothionamide, Ethionamide and PAS. The median duration of treatment was 18 months (range 12-24). None had features of active disease at their last assessment and the 6 pulmonary cases were sputum negative. CONCLUSION: The outcome was better than previously reported [Goble et al New Engl J Med 1993;328:527-32]. Apart from one death, we obtained disease-free survival in 7 cases followed up for two years or more, those not tested for HIV being presumed negative. However, risk factors for MDR-TB were often not recognised early; optimal drug regimens should be better defined.