BACKGROUND: We assessed a programme of tuberculosis control in a prison setting in Baku, Azerbaijan. The programme used first-line therapy and DOTS (directly observed treatment, short course). METHODS: 467 patients had sputum-positive tuberculosis. Their treatment regimens followed WHO guidelines, and they had regular clinical examinations and dietary supplements. Isolates were tested by standard methods for resistance to isoniazid, rifampicin, ethambutol, and streptomycin in three laboratories. Treatment success was defined as three consecutive negative sputum smears at end of treatment. Factors independently associated with treatment failure were estimated by logistic regression. FINDINGS: Drug-resistance data on admission were available for 131 patients. 55% of patients had strains of Mycobacterium tuberculosis resistant to two or more antibiotics. Mortality during treatment was 11%, and 13% of patients defaulted. Overall, treatment was successful in 54% of patients, and in 71% of those completing treatment. 104 patients completed a full treatment regimen and remained sputum-positive. Resistance to two or more antibiotics, a positive sputum result at the end of initial treatment, cavitary disease, and poor compliance were independently associated with treatment failure. INTERPRETATION: The effectiveness of a DOTS programme with first-line therapy fell short of the 85% target set by WHO. First-line therapy may not be sufficient in settings with a high degree of resistance to antibiotics.
BACKGROUND: We assessed a programme of tuberculosis control in a prison setting in Baku, Azerbaijan. The programme used first-line therapy and DOTS (directly observed treatment, short course). METHODS: 467 patients had sputum-positive tuberculosis. Their treatment regimens followed WHO guidelines, and they had regular clinical examinations and dietary supplements. Isolates were tested by standard methods for resistance to isoniazid, rifampicin, ethambutol, and streptomycin in three laboratories. Treatment success was defined as three consecutive negative sputum smears at end of treatment. Factors independently associated with treatment failure were estimated by logistic regression. FINDINGS: Drug-resistance data on admission were available for 131 patients. 55% of patients had strains of Mycobacterium tuberculosis resistant to two or more antibiotics. Mortality during treatment was 11%, and 13% of patients defaulted. Overall, treatment was successful in 54% of patients, and in 71% of those completing treatment. 104 patients completed a full treatment regimen and remained sputum-positive. Resistance to two or more antibiotics, a positive sputum result at the end of initial treatment, cavitary disease, and poor compliance were independently associated with treatment failure. INTERPRETATION: The effectiveness of a DOTS programme with first-line therapy fell short of the 85% target set by WHO. First-line therapy may not be sufficient in settings with a high degree of resistance to antibiotics.
Authors: M C Ruddy; A P Davies; M D Yates; S Yates; S Balasegaram; Y Drabu; B Patel; S Lozewicz; S Sen; M Bahl; E James; M Lipman; G Duckworth; J M Watson; M Piper; F A Drobniewski; H Maguire Journal: Thorax Date: 2004-04 Impact factor: 9.139
Authors: Carole D Mitnick; Sonya S Shin; Kwonjune J Seung; Michael L Rich; Sidney S Atwood; Jennifer J Furin; Garrett M Fitzmaurice; Felix A Alcantara Viru; Sasha C Appleton; Jaime N Bayona; Cesar A Bonilla; Katiuska Chalco; Sharon Choi; Molly F Franke; Hamish S F Fraser; Dalia Guerra; Rocio M Hurtado; Darius Jazayeri; Keith Joseph; Karim Llaro; Lorena Mestanza; Joia S Mukherjee; Maribel Muñoz; Eda Palacios; Epifanio Sanchez; Alexander Sloutsky; Mercedes C Becerra Journal: N Engl J Med Date: 2008-08-07 Impact factor: 91.245
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Authors: Sarah E Smith; Robert Pratt; Lisa Trieu; Pennan M Barry; Dzung T Thai; Shama Desai Ahuja; Sarita Shah Journal: Clin Infect Dis Date: 2017-10-16 Impact factor: 9.079