Five Years of Managing Multidrug-Resistant Tuberculosis at PMDT Mardan: Treatment Outcomes, Challenges, and Key Insights

Original Article

Abstract

Background: Multidrug-resistant tuberculosis (MDR-TB) remains a global public health concern, particularly in low- and middle-income countries such as Pakistan.

Objective: This study aimed to evaluate treatment outcomes, challenges, and key lessons from five years of MDR-TB management at the Programmatic Management of Drug-Resistant Tuberculosis (PMDT) site, MTI Mardan.

Methodology: A retrospective cohort of 161 patients with bacteriologically confirmed resistance to at least isoniazid and rifampicin was reviewed. Data were analyzed using SPSS v25.

Results: The treatment success rate was 85%, with 16% of patients showing poor outcomes (death, failure, or loss to follow-up). Adverse drug reactions (ADRs) occurred in 45%, mainly gastrointestinal intolerance, hepatotoxicity, and ototoxicity. Comorbidities such as diabetes mellitus (25%) and chronic lung disease (38%) were key determinants of outcome. Resistance to fluoroquinolones (35%) and second-line injectables (25%) was common. Predictors of poor outcomes included diabetes, fluoroquinolone resistance, multiple prior TB treatments, severe ADRs, malnutrition, and advanced age.

Conclusion: While the PMDT Mardan site achieved an encouraging success rate, challenges persist regarding ADRs, comorbidities, and drug resistance. Strengthened pharmacovigilance, individualized regimens, and multidisciplinary management are essential for optimizing outcomes.