Evaluation of a directly observed six month fully intermittent treatment regimen for tuberculosis in patients suspected of poor compliance
Evaluation of a directly observed six month fully intermittent treatment regimen for tuberculosis in patients suspected of poor compliance
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DOI：
10.1136/thx.51.11.1130
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发表时间：
1996-11-01
期刊：
影响因子：
10
通讯作者：
Cabrera, P
中科院分区：
文献类型：
--
作者：
Caminero, JA;Pavon, JM;Cabrera, P
背景--尽管结核病控制的首要任务是达到最高治愈率，但在特定的高危人群中，方法：1990年1月至1994年12月102例肺结核患者，对治疗依从性差的患者（96例肺内，6例肺外）采用6个月完全间歇（每周两次）直接观察方案进行治疗。他们包括71名无家可归的受试者，50名慢性酗酒者，23名静脉注射药物滥用者，9名艾滋病毒感染者，11名先前放弃了每日抗结核治疗方案的受试者; 53名受试者有一个以上的这些风险因素。治疗包括异烟肼和利福平6个月，吡嗪酰胺在前两个月。连续两次未能服用药物的患者，积极寻求通过电话或个人search.Results -治疗两个月后，102例患者中有95例定期服用药物，其中90例培养阴性。其余4名患者在3个月后培养结果为阴性。在六个月结束时，87名患者完成了治疗，被认为治愈。只有15名患者放弃了治疗（其中13人有一个以上的风险因素）。在102例患者中，仅3例在1年随访时复发，88例在2年随访时复发。两名患者因严重副作用而需要改变治疗。虽然静脉注射药物滥用是唯一的预测不遵守多变量分析，如果在治疗的第二个月的可用变量进行了分析，目前的依从性差，放弃治疗，在过去被发现显着相关noncompliance.Conclusions -这项研究表明，这种间歇性方案的疗效和直接观察到的治疗方案的有效性。
Background - Although a priority for tuberculosis control is to achieve the maximum cure rate, compliance with chemotherapy in specific high risk groups (homeless, intravenous drug abusers, chronic alcoholics) is usually poor.Methods - From January 1990 to December 1994 102 patients with tuberculosis (96 pulmonary, six extrapulmonary) who were poorly compliant with treatment were treated with a six month fully intermittent (twice weekly) directly observed regimen. They comprised 71 homeless subjects, 50 chronic alcoholics, 23 intravenous drug abusers, nine infected with HIV, and 11 who had previously abandoned a daily antituberculosis regimen; 53 had more than one of these risk factors. Treatment included isoniazid and rifampicin for six months and pyrazinamide during the first two months. Patients who failed to take their medication on two consecutive occasions were actively sought by telephone or by personal search.Results - After two months of treatment 95 of the 102 patients had taken their medication regularly and 90 of them had negative cultures. Four of the remaining patients had negative cultures after three months. At the end of the six months 87 patients had completed treatment and were considered cured. Only 15 patients abandoned the treatment (13 of whom had more than one risk factor). Only three relapses occurred in the 102 patients at one year follow up and in the 88 patients followed for two years. Two patients required a change of treatment due to major side effects. Although intravenous drug abuse was the only predictor of noncompliance in the multivariate analysis, if the available variables in the second month of treatment were analysed, current poor compliance and abandonment of treatment in the past were found to be significantly associated with non-compliance.Conclusions - This study shows the efficacy of this intermittent regimen and the effectiveness of a directly observed treatment programme.