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Biomedical subjects

T S Moulding

Publications and source records attributed to T S Moulding.

At least 19 recordsLinked to original sources
PubMed2004

Preventing drug-resistant tuberculosis with a fixed dose combination of isoniazid and rifampin.

SETTING: Los Angeles County Department of Health Services. OBJECTIVE: To determine how well a self-administered fixed dose combination of isoniazid and rifampin (CombinedHR) prevents acquired drug resistance to Mycobacterium tuberculosis despite treatment interruptions. DESIGN: Self-administered CombinedHR was given to approximately 75% of patients and directly observed therapy or separate drugs to 25%. Three quarters of the patients completed the prescribed treatment. We determined 1) how many patients had two drug-susceptible cultures 3 or more months apart as a measure of drug-susceptible failure or relapse, 2) how many patients whose initial culture was drug-susceptible had a subsequent drug-resistant culture as a measure of acquired drug resistance, and 3) what treatment regimen was taken by each patient who developed acquired drug resistance. RESULTS: Among 5337 drug-susceptible tuberculosis patients who were known or presumed to be human immunodeficiency virus (HIV) negative, 152 (2.84%) treatment failures or relapses occurred, of which 25 (0.47%) developed acquired drug resistance. Among approximately 4000 cases taking CombinedHR and primarily CombinedHR, drug resistance occurred in only eight cases (0.2%), and a total of 12 cases (0.3%) when patients with indeterminate treatment histories were added. CONCLUSIONS: Treatment with self-administered CombinedHR results in minimal acquired drug resistance in HIV-seronegative tuberculosis cases despite modest rates of incomplete treatment.

Antibiotics, Antitubercular↗
PubMed2002

Managing medication compliance of tuberculosis patients in Haiti with medication monitors.

SETTING: A tuberculosis clinic in Haiti using self-administered medication. OBJECTIVE: To determine if medication monitors could be used along with directly observed therapy in developing countries to help solve the problem of compliance with medication. DESIGN: Patients were randomized into three groups: Group A took medication from medication monitors and were given counseling based on the monitor record; Group B took medication from medication monitors, but the record was not available for counseling; and Group C took medication from simple containers. RESULTS: Good monitor records in the first 11 weeks predicted less default from treatment (P < 0.01), and better compliance (P < 0.01) in the last 9 months. Counseling based on the monitor record appeared to reduce treatment abandonment by about half. CONCLUSION: This study suggests that medication monitoring of self administered treatment would be useful in settings where directly observed therapy cannot be delivered for the entire duration of treatment, especially in rural areas, by 1) identifying poor compliance early in therapy, 2) reducing the frequency of clinic visits for patients with good monitor records who live excessive distances from the clinic, 3) counseling patients about their monitor record to improve treatment completion rates, and 4) lengthening the duration of therapy when poor compliance is found.

Adolescent↗
PubMed1999

Medication monitors to treat tuberculosis. A supplement to directly observed therapy.

The use of directly observed therapy (DOT) for nearly all cases of pulmonary tuberculosis (TB) is being widely promoted by the Centers for Disease Control, but its implementation is being resisted by many health professionals. Consequently, less than half of the patients in major metropolitan health departments were given DOT in 1996. The usual justification for "universal" DOT instead of selective DOT is the well-known difficulty in differentiating between patients who are reliable in taking medication from those who are not. Devices called medication monitors, which record when medication is removed from a container, were shown to be effective in determining the reliability of TB patients in taking medication in the 1960s but were cumbersome to use. Since then several improved, convenient to use, electronic medication monitors have been introduced and further improvements can be anticipated. These increasingly practical medication monitors need to be studied as a supplement to DOT in order to make selective DOT an effective alternative to "universal" DOT in managing the medication compliance problem when treating TB.

Drug Monitoring↗
PubMed1989

Twenty isoniazid-associated deaths in one state.

Twenty deaths from isoniazid-associated hepatitis are known to have occurred in California over a 14-yr period in persons ranging in age from 5 to 73 yr. Because no comprehensive survey was carried out, more such deaths probably occurred. With one exception, the patients were not seen or contacted monthly throughout the course of treatment. However, in 16 patients where the information was known, eight were seen by a member of the group giving the isoniazid (INH) within 30 days prior to the patients presenting with hepatitis. In 12 of 17 cases, symptoms were present for 7 days or more before the patient presented for medical care. In at least 35% of cases where the information was known, a management error occurred, usually failing to immediately stop INH when the patient presented with symptoms. The duration of treatment before hepatitis developed varied from 9 to 53 wk. Four of the 20 patients had cholelithiasis or a history of cholelithiasis. With one possible exception, no excessive alcohol use was noted. Concomitant acetaminophen, barbiturate, and tetracycline use occurred in several cases. There were no deaths in Orientals. Sixteen of the 20 deaths occurred in women who had started to receive INH between the ages of 15 and 55. Four of these women began receiving INH during pregnancy and continued it postpartum. Eight deaths occurred in persons starting INH before 35 yr of age. The continued occurrence of INH-associated deaths suggests that indications and precautions for INH preventive treatment be carefully reconsidered.

Adolescent↗
PubMed1981

Should isoniazid be used in retreatment of tuberculosis despite acquired isoniazid resistance?

The use of high-dose isoniazid in retreatment regimens for tuberculosis, despite acquired isoniazid resistance, could possibly improve therapeutic results if all or part of the organisms were resistant to only low concentrations of that drug. Furthermore, organisms resistant to low concentrations of isoniazid have been shown, on occasion, to be resistant to 2 of the retreatment drugs, ethionamide and pyrazinamide, whereas higher degrees of isoniazid resistance are associated with susceptibility to these drugs. Use of high-dose isoniazid might improve results in retreatment with ethionamide and pyrazinamide by eliminating any organisms with low degrees of isoniazid resistance that have associated ethionamide and pyrazinamide resistance. Two clinical trials concerning this topic have been reported. A controlled retreatment trial with various combinations of ethionamide, cycloserine, and pyrazinamide with and without conventional "low" doses of isoniazid (300 mg per day) showed no benefit when isoniazid was added. However, a noncontrolled trial using ethionamide and pyrazinamide with and without high doses of isoniazid, 1 to 1.5 g per day, showed marked benefit with the added isoniazid. In view of these conflicting data, the use of high-dose isoniazid in retreatment regimens needs further study, which could probably be carried out in the developing countries.

Dose-Response Relationship, Drug↗
PubMed1979

Health effects of urban air pollution. Special consideration of areas at 1,500 m and above.

Urban air pollution, when sufficiently severe, can cause death in humans; these deaths occur preponderantly among those with increased susceptibility. Pollution--carbon monoxide and oxidants in particular--is capable of aggravating preexisting chronic heart and lung diseases. Pollution and tobacco (especially cigarette) smoke act synergistically in a causative role in chronic bronchitis and in an aggravating role in emphysema. Susceptibility to the effects of urban air pollution varies widely, with the most susceptible being fetuses, the newborn, the elderly, the infirm, those with chronic heart and lung diseases, and those who smoke. The carbon monoxide standards for sea level are probably too lenient for an altitude of 1,500 m and above. Using a broad definition of health, which takes into account concepts such as quality of life and social and mental well-being, few metropolitan residents would deny that their health is compromised by air that is malodorous, that irritates mucous membranes, and that obscures beautiful scenery.

Adult↗
PubMed1979

The unrealized potential of the medication monitor.

The medication monitor is a dispenser with a time recording system for determining when patients remove medication. It has demonstrated that nurses and physicians can estimate patient compliance with considerable accuracy. It could be used: (1) to assure that only patients actually ingesting medication are used to evaluate new drugs, (2) to study the factors that influence compliance and strategies to improve compliance, (3) to prevent escalation to more toxic drugs or expensive diagnostic procedures when failure to respond is due to poor compliance, (4) to supervise compliance when society has an overriding interest in therapeutic success, and (5) to monitor the effects of air pollution. Specially designed medication monitors could be used to provide the proper amount of compensatory medication when a patient forgets and to reduce the chance that a suicidal patient will impulsively take an overdose.

Drug Administration Schedule↗
PubMed1979

Hot water as a tubal occluding agent.

Experimental studies in living rabbits and autopsy human oviducts are presented which demonstrate a reasonable possibility that one could introduce hot water into the proximal portion of the human oviduct with a hysteroscope or balloon catheter, to destroy the epithelium of the first portion of that structure, leading to its occlusion, while still maintaining safety for the woman because the water would cool to tolerable temperatures before it entered the peritoneal cavity. Before trying the procedure in human beings, research on non-human primates is clearly needed.

Animals↗
PubMed1979

The potential uses of the medication monitor in the treatment of leprosy.

A medication monitor has been developed that utilizes radioactive material and photographic film to record the intervals at which patients take medication. In the author's opinion, this equipment represents the most efficient means that has so far become available for determining how regularly outpatients take medication. A monitor for the tuberculosis regimen of isoniazid and thiacetazone has been made at a sufficiently low cost that it is practical to use it in routine treatment programs. An inexpensive system for immediate development of the film that can be used in the most remote locations is also available. Undoubtedly, with appropriate engineering work, a monitor for leprosy regimens could be made. The device has been used with tuberculosis patients and revealed that many patients were grossly irregular in taking their medication. It has been used to oversee medication use by tuberculosis patients and to select those who require either extra attention to improve medication ingestion or completely supervised, directly administered programs. In the treatment of leprosy, it could be used to study new drug regimens, the causes of noncompliance, and for the routine supervision of patients.

Humans↗
PubMed1977

Cross-resistance in M. tuberculosis to kanamycin, capreomycin and viomycin.

Drug resistant mutants to streptomycin, kanamycin, viomycin, capreomycin, and rifampicin were isolated from four strains of Mycobacterium tuberculosis. The mutants isolated from each parent were then tested for evidence of development of cross-resistance to other drugs. There was no cross-resistance between either streptomycin or rifampicin and any of the other drugs. Complete cross-resistance between viomycin and capreomycin was found. Cross-resistance between kanamycin and capreomycin, and kanamycin and viomycin was variable. A review of the medical histories of 27 patients with kanamycin-resistant tubercle bacilli indicated that cross-resistance with capreomycin and viomycin occurs, but is unpredictable. Because of this variability in cross-resistance and the fact that kanamycin is a more toxic drug than capreomycin, it is suggested that capreomycin be used in the first retreatment regimen for tuberculosis when streptomycin resistance has been demonstrated.

Capreomycin↗