title: Efficacy of twice weekly treatment for tuberculosis given under direct observation in Africa.
abstract: The efficacy of a 6 months course of twice weekly therapy with 4 drugs for tuberculosis, preceded by a 2-3 weeks intensive daily phase, is unknown. Implementation of this regime as community-based directly observed therapy in Africa is highly effective (85% completion rate); it is important to estimate the efficacy of the regime before advocating its widespread use and before conducting prospective trials. We retrospectively evaluated 109 consecutive adults with culture-positive pulmonary tuberculosis who had documented completion of treatment; 84 (77%) were traced and in 15 (14%) a history was obtained from a close relative; 10 (9%) had left the area. Nineteen patients were producing sputum and 4 of these were culture-positive for Mycobacterium tuberculosis, giving an estimated cure rate of 95% (95% confidence interval, 89-98%). Follow-up specimens revealed no acquired drug resistance and restriction fragment length polymorphism analysis of patient-paired specimens showed them to be nearly identical, indicating that treatment had failed or there had been early relapse. This preliminary study suggested that generally twice weekly 4-drug treatment for tuberculosis, given under direct observation, is curative in an acceptable proportion of patients. Prospective trials are indicated.
authors.affiliation: Centre for Epidemiological Research in Southern Africa (CERSA: Hlabisa), South African Medical Research Council, South Africa. davewilk@iafrica.com
authors.forename: D
authors.initials: D
authors.lastname: Wilkinson
authors.forename: E
authors.initials: E
authors.lastname: Anderson
authors.forename: G R
authors.initials: GR
authors.lastname: Davies
authors.forename: A W
authors.initials: AW
authors.lastname: Sturm
authors.forename: K P
authors.initials: KP
authors.lastname: McAdam
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents; D000995:Antitubercular Agents / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D004977:Ethambutol / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D007538:Isoniazid / Q000008:administration & dosage; D008826:Microbial Sensitivity Tests; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D011718:Pyrazinamide / Q000008:administration & dosage; D012008:Recurrence; D012189:Retrospective Studies; D012293:Rifampin / Q000008:administration & dosage; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology
chemical_list: D000900:Anti-Bacterial Agents; D000995:Antitubercular Agents; D011718:Pyrazinamide; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin