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Free Content Using treatment failure under effective directly observed short-course chemotherapy programs to identify patients with multidrug-resistant tuberculosis

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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.

Keywords: DOTS-Plus; Peru; directly observed therapy; multidrug resistance; treatment failure; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA 2: Department of Social Medicine, Harvard Medical School, Boston, Massachusetts, USA; and Socios En Salud—Sucursal Peru/Partners In Health, Boston, Massachusetts, USA 3: Massachusetts State Laboratory Institute, Boston, Massachusetts, USA 4: Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA; and Department of Population and International Health, Harvard School of Public Health, Boston, Massachusetts, USA 5: Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA

Publication date: February 1, 2000

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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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