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At least 19 recordsLinked to original sources
PubMed1999

Outcome of pulmonary tuberculosis treatment in the tertiary care setting--Toronto 1992/93. Tuberculosis Treatment Completion Study Group.

BACKGROUND: Completion of treatment of active cases of tuberculosis (TB) is the most important priority of TB control programs. This study was carried out to assess treatment completion for active cases of pulmonary TB in Toronto. METHODS: Consecutive cases of culture-proven pulmonary TB were obtained from the microbiology laboratories of 5 university-affiliated tertiary care centres in Toronto in 1992/93. A standard data-collection tool was used to abstract information from inpatient and outpatient charts. For patients who were transferred to other treatment centres or lost to follow-up, the local health unit was contacted for information about treatment completion. If incomplete information was obtained from these sources, data from the provincial Reportable Disease Information System were also reviewed. The main outcome analysed was treatment outcome, with cases classified as completed (record of treatment completion noted), transferred (patient transferred to another centre but no treatment results available), defaulted (record of defaulting in patient chart but no record of treatment completion elsewhere, or patient still receiving treatment more than 15 months after diagnosis) or dead (patient died before treatment completion). RESULTS: Of the 145 patients 84 (58%) completed treatment, 25 (17%) died, 22 (15%) defaulted and 14 (10%) were transferred. The corresponding values for the 22 patients with HIV coinfection were 6 (27%), 5 (23%), 8 (36%) and 3 (14%). Independent predictors of failure to complete treatment were injection drug use (adjusted odds ratio [OR] 5.7, 95% confidence interval [CI] 1.5 to 22.0), HIV infection (adjusted OR 4.6, 95% CI 1.4 to 14.7) and adverse drug reaction (adjusted OR 2.9, 95% CI 1.1 to 7.9). Independent predictors of death included age more than 50 years (adjusted OR 16.7, 95% CI 2.6 to 105.1), HIV infection (adjusted OR 16.1, 95% CI 3.9 to 66.4), immunosuppressive therapy (adjusted OR 8.0, 95% CI 1.9 to 34.4) and infection with a multidrug-resistant organism (adjusted OR 30.7, 95% CI 1.5 to 623.0). INTERPRETATION: Treatment completion rates in tertiary care hospitals in Toronto in 1992/93 were below the rate recommended by the World Health Organization. Careful surveillance of treatment completion is necessary for the management of TB in metropolitan centres in Canada.

Adult↗
PubMed1979

[The importance of estimating the individual acetylation rate in modern tuberculosis treatment].

Modern tuberculosis treatment suggests the intermittent regimens of isoniazid twice or once weekly. To be able to use this procedure, one would require to know the acetylation rate of patients. The advantages of the sulfamethazine acetylation test are, firstly, the method of estimation is simple, requiring only colorimeter or a visible range spectrophotometer. Secondly, the results are available on the same day. Thirdly, specimens do not require cold storage. The findings of the present study indicates that, 62.5 percent of subjects were slow acetylators and 37.5 percent of subjects were rapid acetylators.

Acetylation↗
PubMed1998

Commentary: making tuberculosis treatment available for all.

Tuberculosis is one of the major public health problems that WHO has tackled throughout the last 50 years. During the pre-clinical era treatment consisted of the use of special diets, bed rest in sanatoria, and lung collapse therapy. The case fatality rate 5 years after diagnosis was 50% and treatment in a sanatorium was expensive and available only to the privileged few. The demonstration in the 1960s that ambulatory treatment of tuberculosis (one year of isoniazid and p-aminosalicylic acid) was as effective for patients and their families as treatment in a sanatorium heralded the beginning of the end of the sanatorium era and the beginning of the era of domiciliary treatment, which could be made widely available to many people with the disease in countries where its prevalence was high. Subsequent refinements in combination therapy led, in the 1960s, to the development of intermittent regimens and, in the 1970s, to short-course regimens following the introduction of rifampicin. The currently recommended WHO strategy for tuberculosis control is termed DOTS, which is being promoted globally to free the world from this millennia-old scourge.

Ambulatory Care↗
PubMed1998

Predictors of adherence to tuberculosis treatment in a supervised therapy programme for prisoners before and after release. Study Group of Adherence to Tuberculosis Treatment of Prisoners.

The prison population is a high-risk group for tuberculosis (TB). This investigation aimed to study predictive factors of treatment adherence among prisoners involved in a pilot programme of supervised treatment. The study included TB patients from the Men's Penitentiary Center of Barcelona (MPCB) in 1995. Directly observed therapy (DOT) was carried out in the infirmary or in a methadone programme. Released prisoners were referred to the municipal maintenance methadone programmes (MMP) and other social resources. Incentives and enablers were used to improve compliance (economic aid for nutritional and housing needs, methadone programmes and admittance to a sociosanitary centre). The outcome of the patients' adherence was classified as follows: completed, defaulted, dead or transferred out. Factors associated with adherence were investigated through logistic regression. The programme included 62 patients, 43 of whom were intravenous drug users (IVDU) and 46 were infected with the human immunodeficiency virus (HIV). Nineteen had previously had TB and 32 were released from prison during TB treatment. Overall adherence was 89%; 97% among those who completed treatment in prison, and 79% among those who completed treatment outside prison (p=0.05). Ninety-five per cent of IVDU in an MMP completed treatment. Homeless or alcoholic exprisoners completed treatment only if they were admitted to sociosanitary centres. DOT throughout treatment resulted in better adherence (odds ratio (OR)= 16.80; confidence interval (CI): 2.42-116.2)). Those who were incarcerated throughout treatment also showed better adherence (OR= 7.36; CI: 0.79-48.16). Antituberculosis treatment adherence in prisoners was high even after release with adequate co-ordination among intrapenitentiary and extrapenitentiary programmes. Maintenance methadone programmes proved very useful in intravenous drug users, as did admittance to sociosanitary centres for indigent or alcoholic exprisoners undergoing treatment.

AIDS-Related Opportunistic Infections↗
PubMed1996

[Results of anti-tuberculosis treatment of patients with tuberculosis--children and adolescents treated in Poland in 1993].

Treatment of 581 new cases tuberculosis in 215 children and 366 adolescents reported in 1993 were followed up for 12 months. The results show that 96.6% bacteriologically confirmed cases were cured (93.8% of children and 97.2% of adolescents). Among 409 bacteriologically negative cases (183 children and 222 adolescents) only in 7 (4 children and 3 adolescents) i.e. in 1.7% no radiological improvement was observed. 75.7% of cases BK+ received 4 drugs treatment regimen-85.4% adolescents and 40.6% children. Children with bacteriologically negative tuberculosis were treated with 2 drugs regimen -(53% of cases) and with 3 drugs regimen 43.2% of cases, while in adolescents majority of cases received 4 drugs (59.0%) or 3 drugs (33.8%). In almost all regiments there were INH and RMP. In spite of high efficacy of applied regimens, the duration of treatment was relatively long. In children BK+ , in 87.8% of cases it was longer than 6 months (in 43.8% of cases it was longer than 9 months). In adolescents BK+, in 81.2% of cases duration of treatment was longer than 6 months (in 34.7% it was longer than 9 months). Among cases BK(-), in 82.5% of children duration of treatment was longer than 6 months and 53.7% adolescents BK(-) were treated longer than 6 months.

Adolescent↗
PubMed2000

The comparison of tuberculosis treatments: a short course therapy and the directly observed short course treatment (DOTS), East Java Province, Indonesia.

Tuberculosis has been given great attention as HIV/AIDS has increased. Because HIV causes a higher tuberculosis risk is becoming more and more important better tuberculosis treatment. This study aimed to compare the smear conversion rate between short course therapy and the tuberculosis treatment with directly observed short course therapy (DOTS), in East Java, Indonesia. The average smear conversion rate in short course therapy among 35,292 cases was 94.40% over 5 year period (1989/90-1993/94). The tuberculosis treatment with DOTS was started in 1994/95. In the first 2 years the smear conversion rate were 97.67% (42/43) and 98.00% (196/200), respectively. The smear conversion rate of the treatment with DOTS was significantly higher compared to a short course therapy (p-value: <0.001). Thus, tuberculosis treatment with DOTS should be promoted. The concept of supervision by health workers or health cadres should be applied considering mostly are given by family members. And there should be readiness of tuberculosis staff to do the treatment with DOTS in all levels to expand the coverage.

Antitubercular Agents↗
PubMedDate not supplied

Cutaneous reactions to thiacetazone in Zambia--implications for tuberculosis treatment strategies.

Tuberculosis in patients infected with human immunodeficiency virus (HIV) is a growing threat to public health in Africa. Thiacetazone, one of the continent's most widely used antituberculous agents, may lead to severe cutaneous reactions in the HIV infected individual. We describe the impact of this reaction on the tuberculosis (TB) control programme of a district hospital in Zambia in 1990, and examine the cost implications of changing the standard treatment regime. We carried out a retrospective survey of records of all patients beginning TB treatment in 1990, together with HIV test results and the cost of all treatments given. From this we derived estimates of costs of different regimes which are and could be used in TB control in Zambia. Severe reactions occurred in 18.7% of all HIV seropositive patients receiving thiacetazone, fatally so in 1.2% (odds ratio 16.6). The greatest part of the cost of the current regime is that attributable to the inpatient stay; we estimated that 29.4% of patients would be unable to receive drugs as out-patients but, even allowing for this, rifampicin-based regimes given to outpatients where possible would not cost more than the current strategy. We conclude that ethical and economic considerations support a change to rifampicin-based regimes in areas of Africa where HIV seroprevalence is high.

AIDS-Related Opportunistic Infections↗
PubMed2004

Tuberculosis treatment outcomes: directly observed therapy compared with self-administered therapy.

Effective treatment of tuberculosis requires adherence to a minimum of 6 months treatment with multiple drugs. To improve adherence and cure rates, directly observed therapy is recommended for the treatment of pulmonary tuberculosis. We compared treatment outcomes among all culture-positive patients treated for active pulmonary tuberculosis (n = 372) in San Francisco County, California from 1998 through 2000. Patients treated by directly observed therapy at the start of therapy (n = 149) had a significantly higher cure rate compared with patients treated by self-administered therapy (n = 223) (the sum of bacteriologic cure and completion of treatment, 97.8% versus 88.6%, p < 0.002), and decreased tuberculosis-related mortality (0% vs. 5.5%, p = 0.002). Rates of treatment failure, relapse, and acquired drug resistance were similar between the two groups. Forty-four percent of patients who received self-administered therapy had risk factors for nonadherence and should have been assigned to directly observed therapy. We conclude that treatment plans that emphasize directly observed therapy from the start of therapy have the greatest success in improving tuberculosis treatment outcomes.

Adult↗
PubMed2004

Relationship between self reporting of past history of anti-tuberculosis treatment and radiographic findings in multidrug-resistant tuberculosis.

SETTING: A referral hospital for multidrug-resistant tuberculosis (MDR-TB) patients in KwaZulu-Natal, South Africa. OBJECTIVE: To investigate how self-reporting of past exposure to anti-tuberculosis therapy in MDR-TB patients relates to their chest radiographs. RESULTS: Chest radiographs of 406 patients with bacteriologically confirmed MDR-TB who were admitted to a tertiary referral hospital during 1998-2001 were reviewed. Of 245 patients with chronic radiographic changes, 91% reported previous anti-tuberculosis treatment, while of 161 patients with acute radiographic changes, 70% reported no previous history of TB treatment. CONCLUSION: Self-reporting by patients of previous anti-tuberculosis treatment relates to the duration of disease assessed radiologically, and is much more reliable than previously postulated.

Adult↗
PubMed1997

Systematic review of randomised controlled trials of strategies to promote adherence to tuberculosis treatment.

OBJECTIVE: To determine the effectiveness of strategies to promote adherence to treatment for tuberculosis. IDENTIFICATION: Searches in Medline (1966 to August 1996), the Cochrane trials register (up to October 1996), and LILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud) (1982 to September 1996); screening of references in articles on compliance and adherence; contact with experts in research on tuberculosis and adherence. INCLUSION CRITERIA: Randomised or pseudorandomised controlled trials of interventions to promote adherence with curative or preventive treatment for tuberculosis, with at least one measure of adherence. MAIN OUTCOME MEASURE: Relative risks and 95% confidence intervals for estimates of effect for categorical outcomes. RESULTS: Five trials met the inclusion criteria. The relative risk for tested reminder cards sent to patients who defaulted on treatment was 1.2 (95% confidence interval 1.1 to 1.4), for help given to patients by lay health workers 1.4 (1.1 to 1.8), for monetary incentives offered to patients 1.6 (1.3 to 2.0), for health education 1.2 (1.1 to 1.4), for a combination of a patient incentive and health education 2.4 (1.5 to 3.7) or 1.1 (1.0 to 1.2), and for intensive supervision of staff in tuberculosis clinics 1.2 (1.1 to 1.3). There were no completed trials of directly observed treatment. All of the interventions tested improved adherence. On current evidence it is unclear whether health education by itself leads to better adherence to treatment. CONCLUSIONS: Reliable evidence is available to show some specific strategies improve adherence to tuberculosis treatment, and these should be adopted in health systems, depending on their appropriateness to practice circumstances. Further innovations require testing to help find specific approaches that will be useful in low income countries. Randomised controlled trials evaluating the independent effects of directly observed treatment are awaited.

Attitude to Health↗
PubMed2002

Noncompliance with tuberculosis treatment by patients at a tuberculosis and AIDS reference hospital in midwestern Brazil.

INTRODUCTION: In developing countries, there is little information about the risk factors that predict noncompliance with tuberculosis (TB) treatment in hospitals. OBJECTIVE: This study analyzes possible factors associated with noncompliance with TB treatment among patients treated at HAA. DESIGN: A retrospective cohort study was made including all patients who initiated TB treatment at HAA, from January to December 1998. A standard form was used to review medical records and to collect data on each patient. This data was evaluated in comparison with data from the state TB control program. RESULTS: Of the 341 patients included in the study, 186 (61.2%) were considered cured and 67 (22%) were non-compliant. The factors associated with noncompliance were: previous anti-TB treatment (RR = 1.95, 95% CI 1.29 to 2.93), prescription of drugs other than the standard first-line regimen proposed by the Brazilian Health Ministry (Rifampin + Isoniazide + Pyrazinamide) (RR = 0.54, 95% CI 0.35 to 0.83), the need for hospitalization (RR = 2.19, 95% CI 1.46 to 3.29) and non-inclusion in the hospital s TB Control Program for treatment follow up (RR = 0.54, 95% CI 0.35 to 0.82). SETTING: Anuar Auad Hospital (HAA) Goiânia, Goiás, Brazil. CONCLUSION: Our results indicate the importance of establishing Tuberculosis Control Programs in hospitals, while paying special attention to patients with risk factors for noncompliance with TB treatment.

Acquired Immunodeficiency Syndrome↗
PubMed2002

A prospective, randomized, double-blind study of the tolerability of rifapentine 600, 900, and 1,200 mg plus isoniazid in the continuation phase of tuberculosis treatment.

Once-weekly rifapentine 600 mg plus isoniazid (INH) during the continuation phase treatment of tuberculosis is associated with a relapse rate higher than that of twice-weekly rifampin plus INH. The safety and tolerability of higher rifapentine doses need to be determined. We conducted a prospective, randomized, double-blind trial of rifapentine at three doses (600, 900, and 1,200 mg) plus INH 15 mg/kg once weekly in the continuation phase treatment of culture-positive tuberculosis in 150 human immunodeficiency virus-seronegative adults. Outcome measures were discontinuation of therapy for any reason and adverse events on therapy. Treatment was discontinued in 3 of 52 (6%), 2 of 51 (4%), and 3 of 47 (6%) in the rifapentine 600-, 900-, and 1,200-mg treatment arms, respectively. Only one discontinuation, in the rifapentine 1,200-mg arm, was due to an adverse event possibly associated with study therapy. There was a trend toward more adverse events, possibly associated with study therapy, in the highest-dose arms (p = 0.051). Rifapentine 900-mg, once-weekly dosing appears to be safe and well tolerated and is being evaluated in Phase III efficacy trials of treatment of latent tuberculosis. Further evaluation of the safety and tolerability of rifapentine 1,200 mg is warranted.

Adult↗
PubMed1998

Outcome of first-line tuberculosis treatment in migrants from Vietnam. International Organization for Migration Tuberculosis Working Group.

SETTING: Screening and treatment of tuberculosis in prospective migrants from Vietnam, in the framework of the Orderly Departure Programme. OBJECTIVE: 1) To describe the outcome of first-line tuberculosis treatment, and 2) to investigate the role of prognostic factors on treatment outcome. DESIGN: Cohort of consecutive smear-positive patients identified by screening before departure, and followed up until cure or failure, for a maximum of two years. RESULTS: Seven hundred and twenty-nine patients were consecutively diagnosed with infectious tuberculosis. Patients received directly observed treatment with rifampicin, isoniazid, ethambutol and pyrazinamide for a minimum of 6 months, or until sputum conversion was maintained for 6 consecutive months. The cumulative percentage of cure with first-line treatment was 50.2% (SE = 2%) at 7 months, and 92.8% (SE = 2%) at 24 months. Young patients without cavities achieved the highest percentage of cure. Stratified testing confirmed the negative effect on the chance of cure of age >45 years (P < 0.001), and cavities (P < 0.001), while the effect of previous treatment was not significant (P = 0.105). CONCLUSIONS: While the overall cure rate was satisfactory, older patients and those with cavities required prolonged treatment and reached a less satisfactory level of cure.

Adolescent↗
PubMed1998

Evaluation and determinants of outcome of tuberculosis treatment.

The most important determinant of the outcome of treatment of tuberculosis (TB) patients is the access that they have to reliable diagnosis and treatment services organized within a national tuberculosis programme (NTP) as part of DOTS, the name of the WHO-recommended TB control strategy. Accurate evaluation of treatment outcomes requires inclusion of all patients diagnosed, including those not registered; part of routine NTP management should therefore involve regular cross-checks between laboratory diagnostic registers and NTP treatment registers. Finally, control services should take into consideration the type of TB, the presence of concomitant infection with human immunodeficiency virus (HIV), and patient characteristics.

HIV Seropositivity↗