Prognosis of Mono- and Polydrug Resistant Pulmonary Tuberculosis in the City of Santa Cruz, Bolivia

OBJECTIVE: To evaluate the results of treatment in patients with pulmonary tuberculosis (TB) resistant to one antituberculosis drug (single drug resistance [SDR]) or to more than one drug (polyresistance [PDR]), excluding patients with resistance to the combination of isoniazid and rifampicin (multidrug resistance). PATIENTS AND METHOD: Retrospective review of all the records of patients with pulmonary TB diagnosed in an outpatient clinic in Santa Cruz, Bolivia, from 1983 through 1993 whose first cultures were SDR or PDR and who were started on treatment in the clinic. RESULTS: We identified 368 patients: 276 (75%) with SDR TB and 92 (25%) with PDR TB. There were 164 new patients among the SDR cases (59%) and 41 (45%) among the PDR cases (P<.05). The mean (SD) age of PDR patients was 31.5 (14.2) years and there were 165 (68%) males. The mean age of SDR patients was 29.4 (13.4) years and there were 50 (54%) males. Eleven patients (3%) experienced a change in the type of resistance (SDR: 7 [3%]; PDR: 4 [4%]) and in 119 cases (32%) the initial treatment regimen was changed (SDR: 84 [30%]; PDR: 35 [38%]). One hundred ninety-six SDR patients (71%) and 56 PDR patients (61%) were cured (P>.05). There were no significant differences in the cure rates in either of the 2 groups between new patients and patients with a history of previous treatment. Seventy-three SDR (26%) and 35 PDR patients (38%) failed to complete treatment (P<.05). CONCLUSIONS: The cure rates among patients who presented with SDR TB and PDR TB were similar to those of drug-sensitive patients; there were no significant differences between new and previously treated patients. The low cure rates were due to the high number of patients who abandoned treatment. Unless a system of therapy administered under supervision is set up it is not likely that these figures can be improved in Santa Cruz, Bolivia.