RESPONSE OF STANDARD ATT IN CAVITARY TUBERCULOSIS VERSUS NON- CAVITARY TUBERCULOSIS: A CROSS-SECTIONAL STUDY

Abstract

Background: Tuberculosis (TB) remains a significant global health challenge, with pulmonary tuberculosis (PTB) being the most prevalent form. Cavitary PTB represents a more advanced and severe manifestation, characterized by destructive lung lesions that impede therapeutic penetration and delay bacterial clearance. This clinical phenotype is associated with higher bacillary load and poorer treatment response. Understanding the differential outcomes between cavitary and non-cavitary PTB is essential for optimizing disease management, directing clinical surveillance, and informing therapeutic modifications in high-burden settings.

Objective: To compare sputum conversion, symptom resolution, adverse drug reactions, and clinical outcomes in patients with cavitary and non-cavitary PTB receiving standard first-line anti-tuberculosis therapy (ATT).

Methods: A cross-sectional study was conducted at Combined Military Hospital, Peshawar, including 150 PTB patients (75 cavitary, 75 non-cavitary) treated with a standard six-month ATT regimen comprising Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol. Patient records were reviewed for demographic characteristics, clinical symptoms, laboratory findings, adverse drug reactions, and treatment outcomes. Data analysis was performed using SPSS version 22.0. Independent t-tests and Chi-square tests were applied to compare outcomes between groups, with significance set at p ≤ 0.05.

Results: Sputum conversion rates were significantly lower among cavitary TB patients at 2 months (72% vs. 85%, p = 0.01) and at 6 months (92% vs. 98%, p = 0.03). Symptom persistence at 6 months was also higher in the cavitary group, with cough (34% vs. 22%), fever (20% vs. 10%), and weight loss (18% vs. 8%). Adverse drug reactions were more frequent among cavitary TB patients, including gastrointestinal disturbances (14% vs. 5%, p = 0.02), hepatotoxicity (16% vs. 9%, p = 0.01), and peripheral neuropathy (6% vs. 2%, p = 0.04). Cavitary TB patients experienced longer hospital stays (9.4 ± 3.5 vs. 6.8 ± 2.9 days, p < 0.001) and higher in-hospital mortality (22.5% vs. 12.5%, p = 0.03).

Conclusion: Cavitary PTB was associated with delayed sputum conversion, slower symptomatic recovery, higher rates of adverse drug reactions, prolonged hospitalization, and increased mortality. These findings underscore the need for intensified monitoring, individualized treatment planning, and enhanced supportive care for patients with cavitary TB to improve clinical outcomes.