Using treatment failure under effective directly observed short-course chemotherapy programs to identify patients with multidrug-resistant tuberculosis.
Int J Tuberc Lung Dis
; 4(2): 108-14, 2000 Feb.
Article
em En
| MEDLINE
| ID: mdl-10694087
ABSTRACT
SETTING:
Public ambulatory care centers in three districts of northern metropolitan Lima, Peru.OBJECTIVE:
To document drug resistance patterns of isolates of Mycobacterium tuberculosis from patients identified as treatment failures under a model tuberculosis (TB) control program based on directly observed, short-course chemotherapy (DOT-SCC).DESIGN:
Case series.RESULTS:
In a referred, consecutive sample of 173 patients identified as treatment failures on DOT-SCC, 160 (92.5%) had culture-positive TB. Of those 160, 150 (93.8%) had active, pulmonary multidrug-resistant TB (MDR-TB, resistance to at least isoniazid [INH] and rifampicin [RIF]). Sixty of the 150 (40.0%) had isolates resistant to at least INH, RIF, ethambutol (EMB) and pyrazinamide (PZA), the initial first-line empiric treatment regimen used locally. Forty-four (29.3%) had isolates resistant to at least INH, RIF, EMB, PZA and streptomycin (SM), the first retreatment regimen. This series of patients had isolates resistant to a mean of 4.5 of the ten drugs tested. The local profile of multidrug resistance is very different from that obtained from national data from Peru.CONCLUSION:
In this setting, treatment failure on DOT-SCC is strongly predictive of active MDR-TB. Because of existing local drug resistance patterns in northern Lima, 89.3% of MDR-TB patients identified as treatment failures will receive ineffective therapy with two or fewer secondary TB drugs if they are given the five-drug empiric retreatment regimen endorsed by the World Health Organization. Further short-course chemotherapy for these patients would only serve to amplify ominous existing drug resistance patterns.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Contexto em Saúde:
2_ODS3
/
3_ND
Problema de saúde:
2_cobertura_universal
/
2_enfermedades_transmissibles
/
3_neglected_diseases
/
3_tuberculosis
Assunto principal:
Tuberculose Pulmonar
/
Falha de Tratamento
/
Tuberculose Resistente a Múltiplos Medicamentos
/
Mycobacterium tuberculosis
/
Antituberculosos
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Incidence_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Female
/
Humans
/
Male
País/Região como assunto:
America do sul
/
Peru
Idioma:
En
Revista:
Int J Tuberc Lung Dis
Ano de publicação:
2000
Tipo de documento:
Article
País de afiliação:
Estados Unidos