Shahina Qayyum, Iftekhar Ahmed, Ghazala Ansari.
Ojha Institute of Chest Diseases, Karachi
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ABSTRACT
Introduction: Intermittent regimens can be as effective as daily regimens.  It has the advantage of convenience in directly observed treatment which is considered essential for ambulatory programs. While the DOTS strategy was piloted at Ojha Institute of Chest Diseases in April 1995, a three times a week intermittent regimen was introduced in 1997- 98 at two major out door clinics of Ojha Institute of Chest Diseases. When the nation wide DOTS program was implemented daily regimen was adopted as recommended by national tuberculosis program in all units of Ojha Institute of Chest Diseases.
Objective: The primary objective of the study was to compare the efficacy of intermittent regimen given in 1997-8 with daily regimen administered in same clinics ten years later in terms of sputum conversion an the end of intensive phase and treatment success rate.
Material and method: It was a retrospective analysis. Data entered in Tb 03 registers of 3rd and 4th quarter in of 1997 and 1st and 2nd quarter of 1998 was compared with that entered in 3rd and 4th quarter of 2007 and1st and 2nd quarter of 2008 and quarterly reports of case finding Tb07, sputum conversion Tb 08 and treatment out come Tb 09
Results: Total number of smear positive case in intermittent therapy group was 702 and in daily therapy group was 1120. Male to female ratio and age distribution was similar. Sputum conversion at end of intensive phase was achieved in 582 out of 702 (83%) in intermittent therapy and 896 out of 1120 (80%) in daily therapy group. Success rate was 78.83 % in intermittent therapy and 78% in daily therapy group. Default rate was 20.51% in intermittent therapy in 1997-8 and 13% in daily therapy group 10 years later.
No serious adverse event was reported with intermittent therapy. Minor side effects like itching (in 2.8%), jaundice (in 4.2%) and vomiting (in 9.9%) were observed in this group.
Relapse was observed in 1.2% patients after one year follow up.
Total number of visits for DOTS required by DOTS’ supporter were 66 for daily regimen and 36 for intermittent therapy. Total cost of medicine was 33% less in intermittent therapy for category 1 cases.
Conclusion: TB control program has achieved 100% DOTS coverage in the public sector and is not far in achieving the target of treatment success rate in new pulmonary TB case. However it is struggling to reduce the default rate. This can be reduced by strong network of DOTS supporters, while introduction of intermittent regimen can reduce the number of visits so a person can supervise more patients with lesser effort. It will be advantageous to introduce this regimen in areas   where population is thin and accessibility is difficult due to less developed roads.