RESUMO
BACKGROUND: Multidrug-resistant tuberculosis programs in DOTS-Plus pilot sites in five countries. OBJECTIVES: To calculate sputum conversion time and its relationship to treatment outcome, document the frequency of culture reversions and examine concordance of smear and culture to assess the potential consequences of monitoring by smear microscopy alone. DESIGN: Retrospective cohort analysis of 1926 patients receiving individualized, second-line therapy. RESULTS: Among 1385 sputum culture-positive cases at baseline, 1146 (83%) experienced at least one culture conversion during treatment. Conversion, however, was not sustained in all patients: 201 (15%) experienced initial culture conversion and at least one subsequent culture reversion to positive; 1064 (77%) achieved sustained culture conversion. Median time to culture conversion was 3 months. Among 206 patients whose nal conversion occurred 7-18 months after the initiation of therapy, 71% were cured or had completed treatment. CONCLUSIONS: Prolonged treatment for patients with delayed conversion may be beneficial, as 71% of late converters still achieved cure or completed treatment. This has implications for programs with de ned end points for treatment failure. The interval between rst and nal conversion among patients whose initial con- version is not sustained raises concern with respect to the ongoing debate regarding duration of treatment and the definition of cure.
Assuntos
Antituberculosos/administração & dosagem , Técnicas Bacteriológicas , Terapia Diretamente Observada , Monitoramento de Medicamentos/métodos , Farmacorresistência Bacteriana Múltipla , Mycobacterium tuberculosis/efeitos dos fármacos , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Esquema de Medicação , Estônia , Feminino , Humanos , Letônia , Masculino , Testes de Sensibilidade Microbiana , Microscopia , Mycobacterium tuberculosis/isolamento & purificação , Peru , Filipinas , Projetos Piloto , Estudos Retrospectivos , Federação Russa , Escarro/microbiologia , Fatores de Tempo , Resultado do Tratamento , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/microbiologiaRESUMO
Adverse events associated with second-line drugs have been mentioned as obstacles in the management of multidrug-resistant tuberculosis (MDR-TB). Data on adverse events were collected from five DOTS-Plus sites in Estonia, Latvia, Peru (Lima), the Philippines (Manila) and the Russian Federation (Tomsk Oblast). The results show that among 818 patients enrolled on MDR-TB treatment only 2% of patients stopped treatment, but 30% required removal of the suspected drug(s) from the regimen due to adverse events. The study shows that adverse events are manageable in the treatment of MDR-TB in resource-limited settings provided that standard management strategies are applied.
Assuntos
Antituberculosos/efeitos adversos , Terapia Diretamente Observada , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Adulto , Estônia , Feminino , Humanos , Letônia , Masculino , Adesão à Medicação , Peru , Filipinas , Estudos Retrospectivos , Federação Russa , Resultado do TratamentoRESUMO
Antimicrobial susceptibility patterns of Haemophilus isolates from children in eleven developing nations
Assuntos
Ampicilina/farmacologia , Países em Desenvolvimento , Haemophilus/isolamento & purificação , Haemophilus , Penicilina G/farmacologia , Testes de Sensibilidade Microbiana/normasRESUMO
Antimicrobial susceptibility patterns of Haemophilus isolates from children in eleven developing nations
Se publica en ingles en: Bull WHO 68(2), 1990