P Escalante1, E A Graviss, D E Griffith, J M Musser, R J Awe. 1. Sections of Pulmonary and Critical Care, Institute for the Study of Human Bacterial Pathogenesis, Baylor College of Medicine, Houston, TX, USA. Patricioe@aol.com
Abstract
BACKGROUND: Isoniazid-resistant tuberculosis (INHr-TB) can be treated successfully with several treatment regimens. However, the optimal regimen and duration are unclear. STUDY OBJECTIVE: To analyze the efficacy of treatment regimens used for INHr-TB in the southeastern Texas region. DESIGN: Retrospective cohort study. SETTING: Health-care facilities reporting tuberculosis (TB) patients in the Houston and Tyler areas. SUBJECTS: All patients reported to have INHr-TB from 1991 to 1998. Exclusion criteria included poor compliance, additional first-line drug-resistance (except aminoglycosides), and death before completion of 1 month of treatment. MEASUREMENTS AND RESULTS: Main treatment outcomes were treatment failure, relapse, and TB-related death. Fifty-three of 83 patients were included in the study; aminoglycoside resistance coexisted in 37.5% of isolates. Seven types of treatment regimens were identified. Eighteen patients (34%) received rifampin, pyrazinamide, and ethambutol thrice weekly for 9 months. Four patients (7.5%) had a total effective treatment duration of < 9 months. Thirty patients (56.6%) and 16 patients (30.2%) received thrice-daily and daily treatment regimens, respectively. Forty-nine patients achieved sputum conversion. Treatment failure and death occurred in one patient (1.9%). Three patients (5.7%) experienced relapses. There was a significant difference in total effective treatment time between patients with and without relapses (8.3 +/- 1.1 months vs 11.1 +/- 2.1 months; p < 0.02). Twice-weekly treatment regimens were associated with relapse (p = 0.05). CONCLUSIONS: Several treatment regimens were prescribed for INHr-TB in southeastern Texas. INHr-TB treatment durations were > 7 months, and treatment regimen efficacy was adequate. Twice-weekly treatment was associated with relapse, whereas thrice-weekly and daily treatments performed similarly. A prospective study with different treatment durations is needed to determine the optimal treatment regimen for patients with INHr-TB.
BACKGROUND:Isoniazid-resistant tuberculosis (INHr-TB) can be treated successfully with several treatment regimens. However, the optimal regimen and duration are unclear. STUDY OBJECTIVE: To analyze the efficacy of treatment regimens used for INHr-TB in the southeastern Texas region. DESIGN: Retrospective cohort study. SETTING: Health-care facilities reporting tuberculosis (TB) patients in the Houston and Tyler areas. SUBJECTS: All patients reported to have INHr-TB from 1991 to 1998. Exclusion criteria included poor compliance, additional first-line drug-resistance (except aminoglycosides), and death before completion of 1 month of treatment. MEASUREMENTS AND RESULTS: Main treatment outcomes were treatment failure, relapse, and TB-related death. Fifty-three of 83 patients were included in the study; aminoglycoside resistance coexisted in 37.5% of isolates. Seven types of treatment regimens were identified. Eighteen patients (34%) received rifampin, pyrazinamide, and ethambutol thrice weekly for 9 months. Four patients (7.5%) had a total effective treatment duration of < 9 months. Thirty patients (56.6%) and 16 patients (30.2%) received thrice-daily and daily treatment regimens, respectively. Forty-nine patients achieved sputum conversion. Treatment failure and death occurred in one patient (1.9%). Three patients (5.7%) experienced relapses. There was a significant difference in total effective treatment time between patients with and without relapses (8.3 +/- 1.1 months vs 11.1 +/- 2.1 months; p < 0.02). Twice-weekly treatment regimens were associated with relapse (p = 0.05). CONCLUSIONS: Several treatment regimens were prescribed for INHr-TB in southeastern Texas. INHr-TB treatment durations were > 7 months, and treatment regimen efficacy was adequate. Twice-weekly treatment was associated with relapse, whereas thrice-weekly and daily treatments performed similarly. A prospective study with different treatment durations is needed to determine the optimal treatment regimen for patients with INHr-TB.
Authors: Federica Fregonese; Shama D Ahuja; Onno W Akkerman; Denise Arakaki-Sanchez; Irene Ayakaka; Parvaneh Baghaei; Didi Bang; Mayara Bastos; Andrea Benedetti; Maryline Bonnet; Adithya Cattamanchi; Peter Cegielski; Jung-Yien Chien; Helen Cox; Martin Dedicoat; Connie Erkens; Patricio Escalante; Dennis Falzon; Anthony J Garcia-Prats; Medea Gegia; Stephen H Gillespie; Judith R Glynn; Stefan Goldberg; David Griffith; Karen R Jacobson; James C Johnston; Edward C Jones-López; Awal Khan; Won-Jung Koh; Afranio Kritski; Zhi Yi Lan; Jae Ho Lee; Pei Zhi Li; Ethel L Maciel; Rafael Mello Galliez; Corinne S C Merle; Melinda Munang; Gopalan Narendran; Viet Nhung Nguyen; Andrew Nunn; Akihiro Ohkado; Jong Sun Park; Patrick P J Phillips; Chinnaiyan Ponnuraja; Randall Reves; Kamila Romanowski; Kwonjune Seung; H Simon Schaaf; Alena Skrahina; Dick van Soolingen; Payam Tabarsi; Anete Trajman; Lisa Trieu; Velayutham V Banurekha; Piret Viiklepp; Jann-Yuan Wang; Takashi Yoshiyama; Dick Menzies Journal: Lancet Respir Med Date: 2018-04 Impact factor: 102.642
Authors: Kamila Romanowski; Leslie Y Chiang; David Z Roth; Mel Krajden; Patrick Tang; Victoria J Cook; James C Johnston Journal: BMC Infect Dis Date: 2017-09-04 Impact factor: 3.090
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