Dots and Treatment Results in Patients with Extra-pulmonary Tuberculosis in Osaka City

Purpose] To improve the treatment outcomes by analyzing/evaluating the association between DOTS and treatment outcomes in patients with extra-pulmonary tuberculosis. [Methods] The subjects were patients with extra-pulmonary tuberculosis newly registered in Osaka City between 2012 and 2014. As controls, patients with pulmonary tuberculosis during this period were enrolled. Patients in whom compliance was confi rmed once a month or more were regarded as completing DOTS. [Results] There were 434 patients with extra-pulmonary tuberculosis. Treatment was completed in 73.3% of these patients. Defaulted rates accounted for 9.4%. The mortality rate was 13.4%. Treatment is being conducted in 2.8%. Furthermore, 0.7% was transferred out. The results were unclear in 0.5%. We investigated changes in the DOTS and defaulted rates, excluding patients who died, those who were referred to other hospitals, those receiving treatment, and those whose results were unclear. The DOTS rates in 2012, 2013, and 2014 were 85.5, 87.5, and 91.2%, respectively, showing a slight increase. The defaulted rates were 14.5, 10.7, and 7.8%, respectively, showing a decrease. When comparing the results between the extra-pulmonary and pulmonary tuberculosis patients, the defaulted rates were 11.4 and 6.2 %, respectively; the percentage was signifi cantly higher in the extra-pulmonary tuberculosis patients. The DOTS rates were 87.7 and 97.2%, respectively; the percentage was signifi cantly lower in the extra-pulmonary tuberculosis patients. There were 41 defaulted cases. The reasons were side effects in 41.5%, physicians instructions in 24.4%, selfdiscontinuation/refusal in 22.0%, and preferential treatment for other diseases in 12.2%. In the extra-pulmonary tuberculosis patients, the proportion of those in whom side effects led to defaulted was higher than in the pulmonary tuberculosis patients, and that of those self-discontinuation/refusal was signifi cantly lower. [Conclusion] Although the defaulted rate has decreased with an increase in the DOTS rate in patients with extrapulmonary tuberculosis, both the DOTS and defaulted rates were less favorable than in patients with pulmonary tuberculosis. In the future, it may be necessary to decrease the defaulted rate by intensifying DOTS. Of the reasons for defaulted, side effects and physicians instructions accounted for a high percentage. Therefore, it may be important to provide medical institutions with information.