[Isoprodian in combination with ethambutol and rifampicin in the treatment of tuberculosis (author's transl)].
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SETTING: National Masan Tuberculosis Hospital, Masan, South Korea, a 430-bed tertiary referral hospital specializing in tuberculosis. OBJECTIVE: To evaluate the treatment outcomes of standardized, empiric regimens for multidrug-resistant tuberculosis (MDR-TB). DESIGN: A retrospective analysis of the hospital records of 142 patients with MDR-TB who had failed short-course chemotherapy. Between 1 January 1998 and 30 June 2000, patients were started on one of two standardized, empiric regimens based on previous treatment history. Drug susceptibility testing of the infecting strain was not used to modify the treatment regimen. Treatment was continued for at least 18 months after conversion to a negative culture. RESULTS: Sixty-three patients (44.1%) were cured and discharged from treatment after at least 18 months of negative cultures; 18 (12.7%) failed treatment, 41 (28.9%) defaulted, four died (2.8%), and 15 (10.6%) were transferred to another institution. One patient is still on treatment. Resistance to ofloxacin was the only risk factor related to poor outcome (death or failure) in univariate or multiple logistic regression analysis. CONCLUSIONS: High levels of resistance to second-line drugs are likely a cause of poor outcome of MDR-TB therapy in Korea. Directly observed therapy and other methods to increase patient compliance should be considered nationwide, as they may improve MDR-TB treatment outcomes.
The introduction briefly describes the pathogenesis, classification, diagnosis and modern treatment possibilities. In Africa leprosy is considered endemic. The World Health Organization estimates the total number of cases at 3.5 million. Over the last 20 years, however, the recorded number of cases has decreased dramatically. Increasing mobility on the part of the population, relocation from countryside to the cities, and a tendency towards urbanization are introducing a new dimension to leprosy distribution and the fight against the disease in Africa. Despite the not-inconsiderable financial, material and human resources that have so far been made available--mostly from outside the country--only a small percentage of the presumptive number of leprosy sufferers are receiving an adequate, modern combination therapy. This means that leprosy continues to represent a serious public and individual health problem in Africa.
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The authors review the principles underlying antituberculosis therapy in children. Basing their comment on the published literature, they analyze the properties, pharmacology, toxicity, and side-effects of each medication, and define their dosage and modes of administration.
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Three different partly intermittent regimens were evaluated in order to assess the value of rifampicin (RMP) in the continuation phase of treatment for tuberculosis. Patients suffering from newly diagnosed culture-positive pulmonary tuberculosis were admitted to the trial. All were initially treated daily for 8 weeks with a quadruple combination including RMP. The intensive treatment phase was followed by twice-weekly intermittent treatment for 16 weeks with one of three different combinations, one containing RMP. Of 246 patients, 85 were withdrawn, 7 because of adverse events. At the end of treatment 127 of 135 patients (94,1%) from whom sputum results could be obtained, had negative sputum cultures, and 6 had one colony growth. Of 42 patients who had one or more positive sputum cultures during follow-up of 96 weeks, 6 belonged to the RMP group compared with 20 and 16 of the other groups (P = 0,0244). The results indicate that a combined daily/intermittent regimen containing RMP in both phases can be safely used, whereas a similar regimen with the same duration but not including RMP in the continuation phase, is inferior.
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In Guadeloupe, from January 1980 to December 1984, 420 leprosy patients were put under daily multidrug therapy: 10 mg/kg RMP plus 100 mg DDS during six months for paucibacillary patients, 10 mg/kg RMP plus 100 mg DDS during 24 months supplemented during the 12 first months with 10 mg/kg of a thioamide, ethionamide or protionamide, for multibacillary patients. The approval to the treatment was satisfactory in all the patients with active leprosy, new cases and relapse cases, less in the inactive patients already treated with dapsone only. The patients's compliance to treatment was satisfactory too. The lepra reactions were observed with a 19% frequency which is not different of the 15% frequency of lepra reactions observed in patients treated with DDS only. Hepatitis were observed only in multibacillary patients treated with PTH and RMP with a 14% frequency. Discontinuing treatment with RMP and PTH but not DDS resulted in recovery. When RMP was resumed without PTH, the hepatitis did not recur. All patients responded favorably under multidrug therapy and no relapse was observed among the 45 paucibacillary patients after a four year-surveillance and among the 16 multibacillary patients after a three year-surveillance.
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