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Abdominal tuberculosis: experience with RNTCP category III antitubercular therapy

Sunit K Shukla, Manoj Meena, Govind N Srivastava, Piyush Arora, Chetan B Patil, Ram N Meena.

Abstract
Background: Abdominal tuberculosis as such has been put in seriously ill category III regimen because the therapy of abdominal tuberculosis throws up many challenges, especially those presenting with immune compromised and malnourished state. To accommodate all the accompanying challenges, it is prudent to keep the regimen flexible.

Objective: To study the 30- and 60-day efficacy of daily versus alternate-day self-administered therapy of abdominal tuberculosis in young adults with ileocecal tuberculosis (IC) and mesenteric tubercular lymphadenitis (ML).

Materials and Methods: This study was conducted for a duration of 2 years, starting June 2013, in an outpatient setting of a tertiary referral center in north India. Patients identified during a study of causes of functional abdominal pain syndrome (FAPS) or “only pain” presentation in gastroenterology (GI) outpatient and diagnosed as IC or ML on the basis of contrast-enhanced computerized tomography (CECT) and/or colonoscopy with ileoscopy were given daily (weight based) versus alternate-day revised national tuberculosis control program (RNTCP) category III regimen therapy in a nonrandom manner.

Result: Twelve patients of abdominal tuberculosis were identified: eight cases had IC with varying degrees of gastrointestinal disturbances whereas four had ML with no other organic disease explaining the symptoms. Groups prescribed daily versus alternate-day therapy did not differ significantly because of the presentation as FAPS in young adults. All patients received clinically significant improvement with antitubercular therapy. Four patients prescribed RNTCP category III regimen showed excellent clinical relief. Dyspepsia occurred significantly more with alternate-day therapy.

Conclusion: Self-administered DOTS alternate-day therapy according to RNTCP category III regimen is equally efficacious to daily-weight-based regimen in young adults with abdominal tuberculosis.

Key words: Abdominal, tuberculosis, DOTS, functional abdominal pain syndrome



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