Tuberculosis treatment outcomes - Directly observed therapy compared with self-administered therapy
Tuberculosis treatment outcomes - Directly observed therapy compared with self-administered therapy
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DOI：
10.1164/rccm.200401-095oc
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发表时间：
2004-09-01
影响因子：
24.7
通讯作者：
Daley, CL
中科院分区：
文献类型：
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作者：
Jasmer, RM;Seaman, CB;Daley, CL
结核病的有效治疗需要坚持至少6个月的多种药物治疗。为提高肺结核的治疗依从性和治愈率，建议采用直接观察治疗。我们比较了1998年至2000年加州州弗朗西斯科县所有培养阳性的活动性肺结核患者（n = 372）的治疗结果。在治疗开始时接受直接观察治疗的患者（n = 149）的治愈率显著高于接受自我给药治疗的患者（n = 223）（细菌学治愈率和完成治疗率之和分别为97.8%和88.6%，P < 0.002），并降低了结核病相关死亡率（0%对比5.5%，p = 0.002）。两组的治疗失败率、复发率和获得性耐药率相似。44%接受自我管理治疗的患者存在不依从的风险因素，应被分配到直接观察治疗。我们的结论是，从治疗开始就强调直接观察治疗的治疗计划在改善结核病治疗结果方面取得了最大的成功。
Effective treatment of tuberculosis requires adherence to a minimum of 6 months treatment with multiple drugs. To improve adherence and cure rates, directly observed therapy is recommended for the treatment of pulmonary tuberculosis. We compared treatment outcomes among all culture-positive patients treated for active pulmonary tuberculosis (n = 372) in San Francisco County, California from 1998 through 2000. Patients treated by directly observed therapy at the start of therapy (n = 149) had a significantly higher cure rate compared with patients treated by self-administered therapy (n = 223) (the sum of bacteriologic cure and completion of treatment, 97.8% versus 88.6%, p < 0.002), and decreased tuberculosis-related mortality (0% vs. 5.5%, p = 0.002). Rates of treatment failure, relapse, and acquired drug resistance were similar between the two groups. Forty-four percent of patients who received self-administered therapy had risk factors for nonadherence and should have been assigned to directly observed therapy. We conclude that treatment plans that emphasize directly observed therapy from the start of therapy have the greatest success in improving tuberculosis treatment outcomes.