Treatment of childhood tuberculosis with a six month directly observed regimen of only two weeks of daily therapy
Treatment of childhood tuberculosis with a six month directly observed regimen of only two weeks of daily therapy
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DOI：
10.1097/00006454-200202000-00002
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发表时间：
2002-02-01
影响因子：
3.6
通讯作者：
Starke, JR
中科院分区：
文献类型：
--
作者：
Al-Dossary, FS;Ong, LT;Starke, JR
背景儿童结核病的推荐治疗是6个月，至少使用3种药物。我们研究了一种方案，需要少至58剂，完全由直接观察治疗（DOT），在程序条件下。进行了一项观察性试验，以确定完全DOT 6个月方案治疗儿童肺、胸膜和淋巴结结核的有效性，该方案使用每日2周的异烟肼、利福平和吡嗪酰胺治疗;然后每周2次异烟肼、利福平和吡嗪酰胺治疗6周;随后每周2次异烟肼和利福平治疗16周。所有的治疗都是由卫生部门的工作人员进行的，病人由德克萨斯州休斯顿的儿童结核病诊所进行随访。评估患者的症状、体重、临床或影像学表现以及治疗依从性的变化。在175例可评价儿童（159例肺/胸淋巴结，4例胸膜，12例颈淋巴结）中，81%的儿童在6个月内完成治疗。在接受延长治疗的33例患者中，3例是因为医生的选择，17例对初始治疗反应不足，2例对药物有显著不良反应，16例对DOT的依从性较差。只有37%的患者在治疗结束时疾病完全消退，但所有患者在停止治疗后继续改善。4年后复发1例。该方案的结果与每日治疗持续时间较长的6个月方案相当。由于胸片异常的解决缓慢，因此确定小儿结核病的治疗反应是困难的。DOT是治疗的一个重要方面，但并不能解决治疗依从性的所有问题。
Background. Recommended treatment of childhood tuberculosis is 6 months in duration with at least 3 drugs. We studied a regimen requiring as few as 58 doses, given entirely by directly observed therapy (DOT), under program conditions.Methods. An observational trial was conducted to determine the effectiveness of a completely DOT 6-month regimen for pulmonary, pleural and lymph node tuberculosis in children with the use of 2 weeks of daily isoniazid, rifampin and pyrazinamide therapy; then 6 weeks of twice weekly isoniazid, rifampin and pyrazinamide therapy; followed by 16 weeks of twice weekly isoniazid and rifampin. All therapy was given by workers from the health department, and patients were followed by the Children's Tuberculosis Clinic in Houston, TX. Patients were evaluated for changes in symptoms, weight, clinical or radiographic findings and adherence to therapy.Results. Of the 175 evaluable children (159 pulmonary/thoracic node, 4 pleural, 12 cervical lymph node), 81% of children completed treatment in 6 months. Of the 33 patients who received extended treatment, 3 did so because of physician choice, 17 had an inadequate response to initial therapy, 2 had significant adverse reactions to drugs and 16 had poor adherence to the DOT. Only 37% of patients had complete resolution of disease at the end of treatment, but all continued to improve after therapy was stopped. There was only I patient who relapsed after 4 years.Conclusion. This regimen had results comparable with those of 6-month regimens with longer durations of daily therapy. Determining treatment response in pediatric tuberculosis is difficult because of the slow resolution of chest radiograph abnormalities. DOT is an important aspect of treatment but does not solve all problems with treatment adherence.