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Free Content Retreatment management strategies when first-line tuberculosis therapy fails

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Abstract:

SETTING: Public ambulatory centers in northern Lima, Peru.

OBJECTIVE: To compare two retreatment strategies in Category I failures.

DESIGN: Retrospective cohort study of Category I failures enrolled between February 1997 and October 2001. Strategy A was a nationwide approach, applying a Category II regimen; if that regimen failed, a standardized regimen including second-line drugs was used. Strategy B was a pilot protocol designed to diagnose and treat multidrug-resistant tuberculosis (MDR-TB); this strategy included drug susceptibility testing (DST) and eliminated the Category II regimen.

RESULTS: Of 125 patients that Category I failed to cure, 73 entered Strategy A and 52 entered Strategy B. Almost 90% of those with DST results had MDR-TB. Strategy B was three times more likely than Strategy A to cure patients (79% vs. 38%, RR = 2.9, 95%CI 1.7–5.1) and five times more likely to cure patients than the Category II regimen alone (79% vs. 15%, RR 5.2, 95%CI 3.0–9.2). Strategy B also significantly reduced delays to MDR-TB diagnosis and to the initiation of MDR-TB therapy.

CONCLUSIONS: Under program conditions, a retreatment strategy based on DST and eliminating the Category II regimen can improve clinical outcomes among Category I treatment failures found to have active, infectious MDR-TB.

Keywords: Category I regimen; Category II; DOTS-Plus; multidrug-resistant tuberculosis; treatment failure

Document Type: Regular Paper

Affiliations: 1: National Tuberculosis Control Program, Dirección de Salud III Lima Norte, Lima, Peru 2: Socios En Salud Sucursal Peru/Partners in Health, Lima, Peru; and Department of Social Medicine, Harvard Medical School, Boston, Massachusetts, USA 3: Socios En Salud Sucursal Peru/Partners in Health, Lima, Peru; and and Division of Social Medicine and Health Inequalities, Brigham and Women's Hospital, Boston, Massachusetts, USA

Publication date: 2005-04-01

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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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