First-line tuberculosis therapy and drug-resistant Mycobacterium tuberculosis in prisons.
BACKGROUND
We assessed a programme of tuberculosis control in a prison setting in Baku, Azerbaijan. The programme used first-line therapy and DOTS (directly observed treatment, short course).


METHODS
467 patients had sputum-positive tuberculosis. Their treatment regimens followed WHO guidelines, and they had regular clinical examinations and dietary supplements. Isolates were tested by standard methods for resistance to isoniazid, rifampicin, ethambutol, and streptomycin in three laboratories. Treatment success was defined as three consecutive negative sputum smears at end of treatment. Factors independently associated with treatment failure were estimated by logistic regression.


RESULTS
Drug-resistance data on admission were available for 131 patients. 55% of patients had strains of Mycobacterium tuberculosis resistant to two or more antibiotics. Mortality during treatment was 11%, and 13% of patients defaulted. Overall, treatment was successful in 54% of patients, and in 71% of those completing treatment. 104 patients completed a full treatment regimen and remained sputum-positive. Resistance to two or more antibiotics, a positive sputum result at the end of initial treatment, cavitary disease, and poor compliance were independently associated with treatment failure.


CONCLUSIONS
The effectiveness of a DOTS programme with first-line therapy fell short of the 85% target set by WHO. First-line therapy may not be sufficient in settings with a high degree of resistance to antibiotics.
Coninx
R
R
International Committee of the Red Cross, Geneva, Switzerland. rconinx@icrc.org
Mathieu
C
C
Debacker
M
M
Mirzoev
F
F
Ismaelov
A
A
de Haller
R
R
Meddings
D R
DR
D000328:Adult; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001382:Azerbaijan; D019587:Dietary Supplements; D004977:Ethambutol / Q000627:therapeutic use; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification; D010349:Patient Compliance; D010865:Pilot Projects; D011329:Prisoners; D011330:Prisons; D012293:Rifampin / Q000627:therapeutic use; D013183:Sputum / Q000382:microbiology; D013307:Streptomycin / Q000627:therapeutic use; D015996:Survival Rate; D017211:Treatment Failure; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000517:prevention & control; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000517:prevention & control; D014944:World Health Organization
D000904:Antibiotics, Antitubercular; D000995:Antitubercular Agents; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin; D013307:Streptomycin