RESUMEN
Isoniazid taken daily for 12 mo and isoniazid and rifampin taken daily for 4 mo are both recommended options for patients with radiographic evidence of previous tuberculosis and positive tuberculin skin tests who have not had prior treatment. We compared the completion rates, number of adverse effects, and cost effectiveness of these two regimens. Patients were treated at the San Francisco Tuberculosis Clinic from 1993 through 1996. A Markov model was developed to assess impact on life expectancy and costs. One thousand twenty-two patients, with a mean age of 52 yr, and > 90% foreign born, were treated; 545 received isoniazid and 477 received isoniazid and rifampin. For isoniazid, 79.8% completed 12 mo of therapy and 4.9% had adverse effects versus 83.6% completion, 6.1% adverse effects for isoniazid and rifampin (p > 0.05 for all between-group comparisons). Both regimens increased life expectancy by 1.4-1.5 yr. Compared with isoniazid, isoniazid and rifampin produced net incremental savings of $135 per patient treated. In patients with radiographic evidence of prior tuberculosis who have not been previously treated, isoniazid for 12 mo and isoniazid and rifampin for 4 mo have similar rates of completion and adverse effects, and both increase life expectancy compared with no treatment. Isoniazid and rifampin for 4 mo is cost saving compared with isoniazid alone. This advantage was maintained even when compared with 9 mo of isoniazid, the new American Thoracic Society/Centers for Disease Control (ATS/CDC) recommendation for treatment with isoniazid alone.
Asunto(s)
Antituberculosos/administración & dosificación , Isoniazida/administración & dosificación , Rifampin/administración & dosificación , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/economía , Antituberculosos/economía , Análisis Costo-Beneficio , Esquema de Medicación , Costos de los Medicamentos , Quimioterapia Combinada , Femenino , Costos de la Atención en Salud , Humanos , Isoniazida/efectos adversos , Isoniazida/economía , Esperanza de Vida , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Cooperación del Paciente , Radiografía , Recurrencia , Rifampin/efectos adversos , Rifampin/economía , San Francisco , Tuberculosis Pulmonar/diagnóstico por imagenRESUMEN
A serologic survey was conducted in south-western Mexico to obtain information on human experience with arbovirus infections. Sera were collected from two semitropical areas along the Pacific coast of Oaxaca State, two mountain areas above 1,700 meters and the interior valley at 1,500 meters. Of the 610 sera tested for group A antibody, 4.9 per cent were positive in the hemagglutination-inhibition (HI) test to Venezuelan (VE), 11 per cent to Eastern, and none to Western encephalitis viruses. In neutralization tests the antibody was shown to be probably due to VE virus infections. When sera were screened for group B antibodies in the HI test, 32 per cent were positive with St. Louis encephalitis (SLE), 19 per cent with Ilhéus, and 4 per cent with yellow fever viruses. The pattern of reactions suggested that SLE or an antigenically related virus was responsible for the antibody detected. An unusually high rate was found in a mountain area at 2,000 meters: 41 per cent of 113 persons tested were seropositive to SLE. Of 493 sera screened by complement-fixation test, 6 per cent were positive to Nepuyo, 4 per cent to Patois, and 3 per cent to Tlacotalpan viruses.