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P Chaulet

Publications and source records attributed to P Chaulet.

At least 19 recordsLinked to original sources
PubMed1999

Implementation of fixed-dose combinations in tuberculosis control: outline of responsibilities.

Fixed-dose combinations (FDCs) of antituberculosis drugs have been available on the world market for more than forty years. For more than twenty years rifampicin-containing FDCs have become increasingly visible on the market in combinations of two, three and even four fixed-dose combinations, but in different dosages depending on the country and the region. As a result, instead of simplifying tuberculosis treatment and the application of standardised chemotherapy regimens, the situation has become progressively more complicated, and at the same time neither bioavailability nor patients' safety is guaranteed. It is time to rationalise and extend the use of FDCs in national tuberculosis programmes. International, supranational and national responsibilities must be clearly defined in this process.

Adult↗
PubMed1998

Global surveillance for antituberculosis-drug resistance, 1994-1997. World Health Organization-International Union against Tuberculosis and Lung Disease Working Group on Anti-Tuberculosis Drug Resistance Surveillance.

BACKGROUND: Drug-resistant tuberculosis threatens efforts to control the disease. This report describes the prevalence of resistance to four first-line drugs in 35 countries participating in the World Health Organization-International Union against Tuberculosis and Lung Disease Global Project on Anti-Tuberculosis Drug Resistance Surveillance between 1994 and 1997. METHODS: The data are from cross-sectional surveys and surveillance reports. Participating countries followed guidelines to ensure the use of representative samples, accurate histories of treatment, standardized laboratory methods, and common definitions. A network of reference laboratories provided quality assurance. The median number of patients studied in each country or region was 555 (range, 59 to 14,344). RESULTS: Among patients with no prior treatment, a median of 9.9 percent of Mycobacterium tuberculosis strains were resistant to at least one drug (range, 2 to 41 percent); resistance to isoniazid (7.3 percent) or streptomycin (6.5 percent) was more common than resistance to rifampin (1.8 percent) or ethambutol (1.0 percent). The prevalence of primary multidrug resistance was 1.4 percent (range, 0 to 14.4 percent). Among patients with histories of treatment for one month or more [corrected], the prevalence of resistance to any of the four drugs was 36.0 percent (range, 5.3 to 100 percent), and the prevalence of multidrug resistance was 13 percent (range, 0 to 54 percent). The overall prevalences were 12.6 percent for resistance to any of the four drugs [corrected] (range, 2.3 to 42.4 percent) and 2.2 percent for multidrug resistance (range, 0 to 22.1 percent). Particularly high prevalences of multidrug resistance were found in the former Soviet Union, Asia, the Dominican Republic, and Argentina. CONCLUSIONS: Resistance to antituberculosis drugs was found in all 35 countries and regions surveyed, suggesting that it is a global problem.

Antitubercular Agents↗
PubMed1998

After health sector reform, whither lung health?

Health sector reform, which is currently taking place in low or middle income countries following the implementation of structural adjustment programmes, advocates the use of rational measures aimed at increasing the efficiency of the health services. These measures are being applied unevenly. Cuts in governments' social budgets have had the effect of favouring the development of the private medical and pharmaceutical sector, rather than rationalising the choice of priorities. The emphasis on cost recovery in basic health services is penalising the poorest and most vulnerable groups. In developing countries, a managerial approach that does not take into account the socio-political structures of these countries and the priorities of health policies only serves to aggravate the inequalities inherent in obtaining access to health care. Under these circumstances, the promotion of lung health runs the risk of being forgotten or compromised. The persisting or worsening weaknesses of the basic health services do not facilitate the application of an integrated approach to respiratory diseases (including tuberculosis), nor the support of a minimum package of health activities to offer to the population. Environmental factors affecting respiratory health (such as smoking and air pollution) are not taken into account in health sector reform, even though they constitute an obvious threat and demand urgent, widespread action. It is a new challenge for health personnel to promote and guarantee lung health.

Africa↗
PubMed1997

[Control of tuberculosis in refugees and displaced].

As a result of national and international conflicts, the number of refugees and displaced persons in various countries of the world is increasing. The complex and protracted nature of these conflicts often forces refugees to remain away from their countries for long periods, living in refugee camps. Many refugees come from countries where tuberculosis is endemic and, once the immediate problems of establishing a camp are overcome, this disease becomes the principal problem affecting refugee camps. In order to advise the persons in charge of refugee camps on how to set up tuberculosis control programs, this document details the general requirements and specific recommendations of WHO for the implementation of such programs, as well as guidelines for their evaluation and monitoring, including criteria that would justify camp closure.

Humans↗
PubMed1995

[Clinical trial of a combination of three drugs in fixed proportions in the treatment of tuberculosis. Groupe de Travail sur la Chimiothérapie de la Tuberculose].

SETTING: The Matiben Chest Clinic at the West Algiers University Teaching Hospital, and 3 outpatient clinics specializing in tuberculosis and lung disease in Algiers. OBJECTIVE: To determine the tolerance and efficacy of a fixed proportion combination of 3 antituberculosis drugs (per tablet: 50 mg isoniazid + 120 mg rifampicin + 300 mg pyrazinamide) given during the first 2 months of a daily 6-month chemotherapy regimen. DESIGN: Random prospective treatment trial comparing a group of 124 patients receiving the triple combination with another group of 126 patients receiving the 3 drugs separately during the initial treatment phase. The continuation phase was identical for the 2 groups. Comparison of tolerance in the first 2 months, and of the failure and relapse rates (respectively at the end of treatment and 24 months after the end of treatment). RESULTS: During the first 2 months side-effects were significantly more common in the group receiving the drugs separately. At the end of treatment and during the following 24 months there were no significant differences in the cumulative rates of observed failures and relapses (2% and 1%). CONCLUSION: The triple combination studied could replace the separate drugs in the initial treatment phase in countries where the bioavailability of the drugs used has been proven.

Adolescent↗
PubMed1995

Surveillance of drug resistance for tuberculosis control: why and how?

The resistance of Mycobacterium tuberculosis to antibiotics, which reflects the quality of the chemotherapy applied in the community, is one of the elements of epidemiological surveillance used in national tuberculosis programmes. Measurement of drug resistance poses problems for biologists in standardization of laboratory methods and quality control. The definition of rates of acquired and primary drug resistance also necessitates standardization in the methods used to collect information transmitted by clinicians. Finally, the significance of the rates calculated depends on the choice of the patients sample on which sensitivity tests have been performed. National surveys of drug resistance therefore require multidisciplinary participation in order to select the only useful indicators: rates of primary resistance and of acquired resistance. These indicators, gathered in representative groups of patients over a long period, are a measurement of the impact of modern chemotherapy regimens on bacterial ecology.

Adolescent↗
PubMed1995

The supply of antituberculosis drugs: price evolution.

The cost of antituberculosis drugs and chemotherapy regimens has fallen sharply in the last 2 years. This evolution in the international market, although attenuated by local currency devaluation, should encourage the directors of national tuberculosis programmes to quantify their needs more clearly and to organise centralised purchasing of antituberculosis drugs from non-profitmaking suppliers offering quality controlled generic drugs at the lowest prices.

Antitubercular Agents↗
PubMed1994

[Curative treatment of tuberculosis in the world].

Recent WHO recommendations for the treatment of tuberculosis have emphasized the need for simplicity and standardization of short term chemotherapy regims which can be applied in all forms of tuberculosis, including both pulmonary and extrapulmonary forms. But in order for the recommended chemotherapy regimes to be effective, there is a need for precise organization. Patient care must begin with the first consultation, dosage must be adapted to patient weight, drug intake must, at least during the initial phase of treatment, be supervised and patients who are absent or irregular should be recalled, surveillance and correction of rare side effects should be recorded, global consideration of the patient's medical and social problems and laboratory (and clinical) check-ups at the end of the initial phase of treatment and again at the end of treatment. Together, the aim of these technical and organizational measures is the limit the development bacterial resistance both to isoniazid and to rifampicin. In countries with limited financial resources, where the majority of the tuberculosis population lives, a reliable network of laboratories equipped with microscopes and a permanent anti-tuberculosis supply organization are required for any and all treatment programmes. In all countries, the evaluation of results using representative cohorts and surveillance of bacterial resistance provide evidence that such policies are successful.

Humans↗
PubMed1992

The supply of antituberculosis drugs and national drugs policies.

The money necessary for purchasing antituberculosis drugs in a national programme comes from the Public Health Services budget, funds from the health insurance scheme (when it exists) and household budgets. The Public Health Services budget is on average $2-23 US per year and per person in low or middle income countries. Average drug consumption in these groups of countries was from $2-26 US per person in 1990. The number of patients to be treated depends on the annual risk of tuberculous infection (ARTI) and the case detection rate: it is the same when the ARTI is 1% and the detection rate 100%, and when the ARTI is 2% and the detection rate 50% of cases. The supply of antituberculosis drugs has a real cost representing around 3% of global drug consumption in low income countries and is always less than 1% of global drug consumption in middle income countries. In most developing countries it could be covered with the aid of national financial resources, on condition that it is integrated into a coherent national drugs policy aimed at guaranteeing the continued availability of essential drugs.

Antitubercular Agents↗