title: A 62-dose, 6-month therapy for pulmonary and extrapulmonary tuberculosis. A twice-weekly, directly observed, and cost-effective regimen.
abstract: OBJECTIVE
  To evaluate the efficacy and toxicity of a 62-dose, four-drug, 6-month, and directly observed regimen for treatment of pulmonary and extrapulmonary tuberculosis.
  
  
  METHODS
  An open, nonblinded clinical trial, with intended follow-up of patients for 36 months after the completion of therapy.
  
  
  METHODS
  A metropolitan tuberculosis clinic in a public health department.
  
  
  METHODS
  From March 1981 through April 1989, we enrolled 160 patients with suspected or known tuberculosis; 35 of these patients were excluded from the analysis.
  
  
  METHODS
  Isoniazid, rifampin, pyrazinamide, and streptomycin were administered daily for 2 weeks; these drugs were then given in higher doses twice weekly for 6 weeks, followed by isoniazid and rifampin twice weekly for 6 weeks, followed by isoniazid and rifampin twice weekly for 18 weeks. A total of 62 doses were administered, and all therapy was directly observed by a nurse or an outreach worker.
  
  
  RESULTS
  Of the 125 evaluable patients, 101 (81%) had pulmonary tuberculosis, 7 (6%) had both pulmonary and extrapulmonary involvement, and 17 (13%) had extrapulmonary disease only. Seventy-one (57%) patients had a history of recent alcoholism. There were two relapses (1.6% +/- 2.2%), occurring 6 and 56 months after the completion of therapy. The time at which sputum samples became culture negative in pulmonary patients ranged from 1 to 19 weeks (median, 4.6 weeks); 40% +/- 9.6% of patients were culture-negative after 4 weeks of therapy, 75% +/- 8.5% after 8 weeks, 94% +/- 4.7% after 12 weeks, 97% +/- 3.3% after 16 weeks, and 100% after 20 weeks. Adverse drug reactions included hyperuricemia (greater than 178 mumol/L [3 mg/dL] above normal) secondary to pyrazinamide in 80 patients (64%), twofold or greater elevations of aspartate aminotransferase in 21 patients (17%), 1.5-fold or greater elevations of alkaline phosphatase in 33 patients (27%), cutaneous abnormalities in 8 patients (6%), nausea in five patients (4%), and dizziness in 1 patient (1%).
  
  
  CONCLUSIONS
  This 62-dose, largely twice-weekly tuberculosis treatment regimen is efficacious and relatively nontoxic and is especially useful for patients in whom directly observed therapy is indicated.
authors.affiliation: Denver Department of Health and Hospitals, Colorado.
authors.forename: D L
authors.initials: DL
authors.lastname: Cohn
authors.forename: B J
authors.initials: BJ
authors.lastname: Catlin
authors.forename: K L
authors.initials: KL
authors.lastname: Peterson
authors.forename: F N
authors.initials: FN
authors.lastname: Judson
authors.forename: J A
authors.initials: JA
authors.lastname: Sbarbaro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001219:Aspartate Aminotransferases / Q000097:blood; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007538:Isoniazid / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D011718:Pyrazinamide / Q000008:administration & dosage; D012008:Recurrence; D012293:Rifampin / Q000008:administration & dosage; D013183:Sputum / Q000382:microbiology; D013307:Streptomycin / Q000008:administration & dosage; D014376:Tuberculosis / Q000188:drug therapy* / Q000191:economics; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000191:economics
chemical_list: D000995:Antitubercular Agents; D011718:Pyrazinamide; D001219:Aspartate Aminotransferases; D007538:Isoniazid; D012293:Rifampin; D013307:Streptomycin