Drug Sensitivity Pattern among Category –I Relapse Cases of Pulmonary Tuberculosis and Its Correlation with Pre- treatment Sputum and Radiological Status

Background: An increased incidence of drug resistance is seen even after active implementation of directly observed treatment short course (DOTS). Early diagnosis of such cases can be improved by performing DST (drug sensitivity test) in all relapse cases. Objective: To know the drug sensitivity pattern and emergence of drug resistance among the category I relapse cases of pulmonary tuberculosis by culture of sputum & drug sensitivity. Material and methods: In this prospective analysis, we have studied the pattern of drug resistance met with in Mycobaclerium tuberculosis isolates obtained from 102 relapse cases who have completed category-I treatment under DOTS. Results: A very high prevalence of MDR-TB (35.29%) is seen among the category I relapse cases. An increased drug resistance among relapse cases correlated well with extensive disease with cavitation radiologically and heavy sputum bacillary load in their pre treatment status. Conclusions: We conclude that all relapse cases should be evaluated for sputum culture and drug sensitivity at the earliest to know about the sensitivity pattern before putting them on category 2. DOTS therapy needs to consider some individualization of treatment based on case specific circumstances, not routinely but atleast for those patients with very extensive disease with cavitation and heavy bacillary load in the sputum.