Retreatment management strategies when first-line tuberculosis therapy fails
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.
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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