First-line tuberculosis therapy and drug-resistant Mycobacterium tuberculosis in prisons
First-line tuberculosis therapy and drug-resistant Mycobacterium tuberculosis in prisons
复制标题
DOI：
10.1016/s0140-6736(98)08341-x
复制
发表时间：
1999-03-20
期刊：
影响因子：
168.9
通讯作者：
Meddings, DR
中科院分区：
文献类型：
--
作者：
Coninx, R;Mathieu, C;Meddings, DR
背景：我们评估了阿塞拜疆巴库一所监狱的结核病控制规划。该规划采用一线治疗和短程化疗（短程直接观察治疗）。方法467例痰液阳性结核患者。他们的治疗方案遵循世卫组织指南，并定期进行临床检查和膳食补充。在三个实验室采用标准方法检测分离株对异烟肼、利福平、乙胺丁醇和链霉素的耐药性。治疗成功定义为治疗结束时连续三次痰涂片阴性。通过逻辑回归估计与治疗失败独立相关的因素。结果131例患者入院时获得耐药数据。55%的患者具有对两种或两种以上抗生素耐药的结核分枝杆菌菌株。治疗期间的死亡率为11%，13%的患者不接受治疗。总体而言，54%的患者治疗成功，71%的患者完成治疗。104名患者完成了完整的治疗方案并保持痰液阳性。对两种或两种以上抗生素的耐药性、初始治疗结束时痰液结果阳性、腔疾病和依从性差是与治疗失败独立相关的。采用一线治疗的直接督导下短程化疗规划的有效性未能达到世卫组织设定的85%的目标。在对抗生素高度耐药的环境中，一线治疗可能是不够的。
Background We assessed a programme of tuberculosis control in a prison setting in Baku, Azerbaijan. The programme used first-line therapy and DOTS (directly observed treatment, short course).Methods 467 patients had sputum-positive tuberculosis. Their treatment regimens followed WHO guidelines, and they had regular clinical examinations and dietary supplements. Isolates were tested by standard methods for resistance to isoniazid, rifampicin, ethambutol, and streptomycin in three laboratories. Treatment success was defined as three consecutive negative sputum smears at end of treatment. Factors independently associated with treatment failure were estimated by logistic regression.Findings Drug-resistance data on admission were available for 131 patients. 55% of patients had strains of Mycobacterium tuberculosis resistant to two or more antibiotics. Mortality during treatment was 11%, and 13% of patients defaulted. Overall, treatment was successful in 54% of patients, and in 71% of those completing treatment. 104 patients completed a full treatment regimen and remained sputum-positive. Resistance to two or more antibiotics, a positive sputum result at the end of initial treatment, cavitary disease, and poor compliance were independently associated with treatment failure.Interpretation The effectiveness of a DOTS programme with first-line therapy fell short of the 85% target set by WHO. First-line therapy may not be sufficient in settings with a high degree of resistance to antibiotics.