Standard short-course chemotherapy for drug-resistant tuberculosis -: Treatment outcomes in 6 countries
Standard short-course chemotherapy for drug-resistant tuberculosis -: Treatment outcomes in 6 countries
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DOI：
10.1001/jama.283.19.2537
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发表时间：
2000-05-17
影响因子：
120.7
通讯作者：
Raviglione, MC
中科院分区：
文献类型：
--
作者：
Espinal, MA;Kim, SJ;Raviglione, MC
背景在世界卫生组织（WHO）结核病控制的直接观察治疗短程策略中，没有大规模研究调查耐多药结核病（TB）对常规全国结核病控制项目条件下标准短程化疗结果的影响。线药物的患者登记在世界卫生组织和国际结核病和肺病防治联盟的全球项目的耐药性监测。设计和设置回顾性队列研究结核病患者在多米尼加共和国，香港特别行政区（中华人民共和国）、意大利、伊万诺沃州（俄罗斯联邦）、大韩民国和秘鲁。1994年至1996年期间分别使用乙胺丁醇或链霉素。主要结果测量根据WHO治疗结果分类的治疗反应结果在6402例结核菌培养阳性病例中，5526例（86%）为新发病例，876例（14%）为复治病例。共有1148例（20.8%）新病例和390例（44.5%）复治病例耐药，分别包括184例和169例耐多药结核病。在新病例中，4585例（83%）获得成功治疗，138例（2%）死亡，151例（3%）短程化疗失败。总体而言，治疗失败（相对风险[RR]，15.4; 95%置信区间[CI]，10.6-22.4; P
Context No large-scale study has investigated the impact of multidrug-resistant tuberculosis (TB) on the outcome of standard short-course chemotherapy under routine countrywide TB control program conditions in the World Health Organization's (WHO) directly observed treatment short-course strategy for TB control.Objective To assess the results of treatment with first-line drugs for patients enrolled in the WHO and the International Union Against Tuberculosis and Lung Disease's global project on drug-resistance surveillance.Design and Setting Retrospective cohort study of patients with TB in the Dominican Republic, Hong Kong Special Administrative Region (People's Republic of China), Italy, Ivanovo Oblast (Russian Federation), the Republic of Korea, and Peru.Patients New and retreatment TB cases who received short-course chemotherapy with isoniazid, rifampicin, pyrazinamide, and either ethambutol or streptomycin between 1994 and 1996.Main Outcome Measure Treatment response according to WHO treatment outcome categories (cured; died; completed, defaulted, or failed treatment; or transferred).Results Of the 6402 culture-positive TB cases evaluated, 5526 (86%) were new cases and 876 (14%) were retreatment cases. A total of 1148 (20.8%) new cases and 390 (44.5%) retreatment cases were drug resistant, including 184 and 169 cases of multidrug-resistant TB, respectively. Of the new cases 4585 (83%) were treated successfully, 138 (2%) died, and 151 (3%) experienced short-course chemotherapy failure. Overall, treatment failure (relative risk [RR], 15.4; 95% confidence interval [CI], 10.6-22.4; P