THE EFFECT OF DIRECTLY OBSERVED THERAPY ON THE RATES OF DRUG-RESISTANCE AND RELAPSE IN TUBERCULOSIS
THE EFFECT OF DIRECTLY OBSERVED THERAPY ON THE RATES OF DRUG-RESISTANCE AND RELAPSE IN TUBERCULOSIS
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DOI：
10.1056/nejm199404283301702
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发表时间：
1994-04-28
影响因子：
158.5
通讯作者：
FORESMAN, BH
中科院分区：
文献类型：
--
作者：
WEIS, SE;SLOCUM, PC;FORESMAN, BH
背景。结核病已重新成为一个重要的公共卫生问题，耐药的频率正在增加。耐药感染和复发的一个主要原因是对医疗方案的依从性差。在德克萨斯州的塔兰特县，我们启动了一项结核病的普遍直接观察治疗计划。我们报告了该计划对结核病患者的原发性和获得性耐药率和复发率的影响。我们收集了1980年1月1日至1992年12月31日、1986年10月期间塔兰特县所有结核分枝杆菌培养阳性患者的信息，患者接受传统的、无监督的药物治疗方案。从1986年11月开始，几乎所有患者都在医护人员的直接观察下接受治疗。1980年1月至1986年10月，共有407例患者接受了传统的结核病治疗；1986年11月至1992年12月，581例患者接受了直接治疗。在这13年期间，尽管静脉注射吸毒和无家可归者的比例较高，结核病的发病率也在上升，但原发性耐药的频率从13.0%下降到6.7%
Background. Tuberculosis has reemerged as an important public health problem, and the frequency of drug resistance is increasing. A major reason for the development of resistant infections and relapse is poor compliance with medical regimens. In Tarrant County, Texas, we initiated a program of universal directly observed treatment for tuberculosis. We report the effect of the program on the rates of primary and acquired drug resistance and relapse among patients with tuberculosis.Methods. We collected information on all patients with positive cultures for Mycobacterium tuberculosis in Tarrant County from January 1, 1980, through December 31, 1992, Through October 1986, patients received a traditional, unsupervised drug regimen. Beginning in November 1986, nearly all patients received therapy under direct observation by health care personnel.Results. A total of 407 episodes in which patients received traditional treatment for tuberculosis (January 1980 through October 1986) were compared with 581 episodes in which therapy was directly observed (November 1986 through December 1992). Despite higher rates of intravenous drug use and homelessness and an increasing rate of tuberculosis during this 13-year period, the frequency of primary drug resistance decreased from 13.0 percent to 6.7 percent (P