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Free Content Replacement of streptomycin by ethambutol in the intensive phase of tuberculosis treatment: no effect on compliance

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SETTING: Seven tuberculosis clinics in the National Tuberculosis Programme of Madagascar.

OBJECTIVE: To compare the treatment efficacy and tolerance of regimens including either streptomycin or ethambutol for patient compliance during initial treatment of smear-positive tuberculosis.

DESIGN: The 1023 patients included in the study were randomly divided into two treatment groups—one to receive streptomycin (S), isoniazid (H), rifampicin (R) and pyrazinamide (Z) (SHRZ), and the other to receive EHRZ, where streptomycin was replaced by ethambutol (E). During the 2-month intensive phase, drug delivery was completely supervised. The same 6-month continuation regimen was then given in both groups. Follow-up consisted of a clinical and bacteriological examination at the end of the second, fifth and eighth months.

RESULTS: There was no significant difference between the two regimens as regards compliance with treatment, the number of patients lost or who died, or for bacteriological response during the intensive phase. EHRZ was better tolerated. During the continuation phase, the results of the two groups remained comparable, but treatment failures occurred earlier in the patients who had received streptomycin.

CONCLUSION: Patient compliance was not better with streptomycin. The ethambutol-containing regimen was as efficient as the other, and better tolerated. There is no argument for preferring streptomycin in the intensive phase of treatment of smear-positive tuberculosis.

Keywords: Madagascar; controlled clinical trial; ethambutol; pulmonary tuberculosis; streptomycin; treatment compliance

Document Type: Regular Paper

Affiliations: 1: Institut Pasteur de Madagascar, Antananarivo, Madagascar 2: Programme National de Lutte Antituberculeuse, Ministère de la Santé, Antananarivo, Madagascar 3: Institut Pasteur de Madagascar, Antananarivo, Madagascar; and Programme National de Lutte Antituberculeuse, Ministère de la Santé, Antananarivo, Madagascar

Publication date: 1999-01-01

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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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