[Shortening of therapy duration in patients with pulmonary tuberculosis from 9 to 6 months only justifiable on the basis of published data].
OBJECTIVE
To determine if in the Netherlands, just like in other countries, the treatment of pulmonary tuberculosis with adequately sensitive tubercle bacilli may be shortened from 9 to 6 months.


METHODS
Literature study.


METHODS
Municipal Health Service, Nijmegen, the Netherlands.


METHODS
The relevant literature was analysed, using the percentage of recurrences as the criterion. The study was restricted to patients with pulmonary tuberculosis in whom the diagnosis had been confirmed bacteriologically and in whom a human, normally sensitive tubercle bacillus had been isolated. The treatment schedule had to include at least isoniazid, rifampicin and pyrazinamide. There were no studies with treatment of 9 months' duration. The studies with 6 months' treatment were selected on the basis of the predetermined criteria from among articles included in Medline in 1980-1991.


RESULTS
The treatment schedules of 6 months' duration (n = 44) from 25 articles were suitable for analysis. Treatment for 6 months' resulted in a proportion of recurrences of tuberculosis of 2.4% (95%-confidence interval: 2.0-2.8), with follow-up periods of 12 to 94 months after discontinuation of the treatment. Addition of streptomycin or ethambutol during the initial phase, self-medication or controlled treatment, daily or intermittent treatment made no difference as regards the ultimate results. No comparison with the proportion of recurrences of 1% (0.2-2.9) after 9 month's treatment without pyranizamide was possible. A recent calculation of the number of Dutch nationals with recurrent tuberculosis resulted in a proportion of recurrences of 2.5 (1.8-3.2). The guideline adopted was that mentioned by the American Thoracic Society, a proportion of recurrences of < 5%.


CONCLUSIONS
On the basis of the known percentages of recurrence, it could be decided in the Netherlands as well to shorten the duration of treatment from 9 to 6 months.
van Loenhout-Rooyackers
J H
JH
GGD Regio Nijmegen.
Veen
J
J
Verbeek
A L
AL
D000995:Antitubercular Agents / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D006801:Humans; D012008:Recurrence; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy*
D000995:Antitubercular Agents