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Free Content How drug resistance emerges as a result of poor compliance during short course chemotherapy for tuberculosis [Counterpoint]

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Objective: To explore mechanisms by which drug resistance might arise as a result of poor compliance during short course chemotherapy.

Design: Four theoretical mechanisms are first described.

Results: Examples of the way the mechanisms probably operate are taken from: 1) a study of once-weekly chemotherapy with streptomycin and isoniazid, and 2) the pattern of drug susceptibility in cultures from patients who relapsed after the end of treatment.

Conclusion: Good compliance is vitally important. The value of a fourth drug in the initial phase of chemotherapy in preventing resistance is questioned. An explanation for mono-resistance to rifampicin in patients with the acquired immune deficiency syndrome (AIDS) is suggested.
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Keywords: compliance; drug resistance; fourth drug; mono-resistance; rifampicin

Document Type: Miscellaneous

Affiliations: Department of Medical Microbiology, St. George's Hospital Medical School, London, UK

Publication date: 1998-01-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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