Asunto(s)
Antituberculosos/uso terapéutico , Control de Enfermedades Transmisibles/métodos , Países en Desarrollo , Salud Global , Accesibilidad a los Servicios de Salud , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Antituberculosos/provisión & distribución , Conducta Cooperativa , Disparidades en Atención de Salud , Humanos , Cooperación Internacional , Programas Nacionales de Salud , Pobreza , Tuberculosis Resistente a Múltiples Medicamentos/epidemiologíaRESUMEN
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.
Asunto(s)
Antituberculosos/administración & dosificación , Mycobacterium tuberculosis/efectos de los fármacos , Insuficiencia del Tratamiento , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/epidemiología , Antituberculosos/farmacología , Países en Desarrollo , Esquema de Medicación , Femenino , Humanos , Incidencia , Masculino , Pruebas de Sensibilidad Microbiana , Mycobacterium tuberculosis/aislamiento & purificación , Perú/epidemiología , Medición de Riesgo , Muestreo , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Tuberculosis Pulmonar/diagnósticoRESUMEN
A field trial was carried out with young cattle grazing molybdenum-rich pastures to test the efficacy of supplying copper salts in drinking water. One group was given two copper injections and 1.8 kg barley supplemented with 125 mg/kg copper, while the other received drinking water containing 2 to 3 mg/litre copper as copper sulphate supplied by means of a proportioner. The results demonstrated that this low concentration of copper in the water was effective in maintaining normal blood levels and in preventing scouring and subsequent loss of condition. The proportioner was capable of finely controlling the level of copper added to the water.