Bacteriologic monitoring of multidrug-resistant tuberculosis patients in five DOTS-Plus pilot projects.
Int J Tuberc Lung Dis
; 15(10): 1315-22, 2011 Oct.
Article
em En
| MEDLINE
| ID: mdl-22283887
ABSTRACT
BACKGROUND:
Multidrug-resistant tuberculosis programs in DOTS-Plus pilot sites in five countries.OBJECTIVES:
To calculate sputum conversion time and its relationship to treatment outcome, document the frequency of culture reversions and examine concordance of smear and culture to assess the potential consequences of monitoring by smear microscopy alone.DESIGN:
Retrospective cohort analysis of 1926 patients receiving individualized, second-line therapy.RESULTS:
Among 1385 sputum culture-positive cases at baseline, 1146 (83%) experienced at least one culture conversion during treatment. Conversion, however, was not sustained in all patients 201 (15%) experienced initial culture conversion and at least one subsequent culture reversion to positive; 1064 (77%) achieved sustained culture conversion. Median time to culture conversion was 3 months. Among 206 patients whose nal conversion occurred 7-18 months after the initiation of therapy, 71% were cured or had completed treatment.CONCLUSIONS:
Prolonged treatment for patients with delayed conversion may be beneficial, as 71% of late converters still achieved cure or completed treatment. This has implications for programs with de ned end points for treatment failure. The interval between rst and nal conversion among patients whose initial con- version is not sustained raises concern with respect to the ongoing debate regarding duration of treatment and the definition of cure.
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Base de dados:
MEDLINE
Assunto principal:
Técnicas Bacteriológicas
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Monitoramento de Medicamentos
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Tuberculose Resistente a Múltiplos Medicamentos
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Terapia Diretamente Observada
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Farmacorresistência Bacteriana Múltipla
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Mycobacterium tuberculosis
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Antituberculosos
Idioma:
En
Ano de publicação:
2011
Tipo de documento:
Article