PP10 TREATMENT OUTCOME AND MANAGEMENT OF ISONIAZID – RESISTANT TUBERCULOSIS PATIENTS IN NORTHERN MALAYSIA

Nur Dalila tt Azmi1, Yusriza Suzane1, Chan Tha1, Arvindran Alaga1
Respiratory Department, Hospital Sultanah Bahiyah

Introduction:

Around 10.6 million new TB cases were diagnosed in 2022, and an estimated 8% have isoniazid mono-resistant TB. It is the most common form of drug-resistant TB. WHO recommends treatment with Rifampicin, Ethambutol, Pyrazinamide, and Levofloxacin (REZL) for duration of 6 months for patients with confirmed rifampicin-susceptible, isoniazid-resistant tuberculosis (Hr-TB).

Objectives:

To identify the incidence, demography, risk factors and treatment outcome associated with Hr-TB patients.

Methodology:

Retrospective study done between January 2021 till December 2023. Hr-TB patients’ information was extracted from our electronic medical record. The incidence of Hr-TB was determined by census data of that particular year. 

Results: 

A total of 966 TB cases treated in our centre were collected, of which 13 cases (1.35%) are Hr-TB, with an incidence age ranging from 24-67 years (mean age 47.5). The majority of the cases are male (69%), and the commonest risk factors are diabetes mellitus (54%), followed by smoking (46%), and drug addiction (15%). 7.7% of cases are associated with previous tuberculous infection, and none of them had previous TB contact. Initiation of treatment with the Hr-TB regime took 14–22 weeks after starting the first-line TB treatment. All patients received treatment with REZL as recommended by the WHO. 1 patient had transaminitis during the course of treatment, while the rest of our cohort patients completed treatment without side effects. A serial chest radiograph shows improvement, and repeated sputum mycobacterial cultures are negative.

Conclusion:

Although there is a delay in the diagnosis of isoniazid resistance based on mycobacterial culture and drug susceptibility testing, the majority of the patients are able to comply with the treatment and achieve a good treatment outcome.