Low failure rate in standardised retreatment of tuberculosis in Nicaragua: patient category, drug resistance and survival of 'chronic' patients.
METHODS
IUATLD collaborative programme, Nicaragua.


OBJECTIVE
To analyse reported trends in the retreatment failure rate (2SRHZE/1RHZE/5R3H3E3), and assess demographic characteristics, drug resistance and survival in patients who fail retreatment.


METHODS
A retrospective, descriptive study. Reports from 1988-1996 were analysed and records of 69 patients who failed retreatment were reviewed.


RESULTS
The treatment success rate in new cases improved from 71% in 1988-1991 to 79% in 1992-1996, the default rate decreased from 16% to 10%, and the failure rate remained stable at 2-3%. The proportion of previously treated patients among all smear-positives decreased from 20% to 15%. In retreatment patients the failure rate declined from 6.6% to 4.3% and the average annual number of failures from 24 to 13. In 1992-1996, 64 patients, 0.8% of new smear-positive cases treated during this period, failed retreatment; the corresponding figures for 1988-1991 are 95 and 1.6%. Among 69 retreatment failure cases reviewed, there was male predominance and increasing age during the study period. Drug susceptibility results were available for 38, of whom 89% were resistant to isoniazid and rifampicin. The median survival of patients after failure was 3.9 years.


CONCLUSIONS
Treatment results improved over the study period. The proportion of patients on retreatment out of all smear positives treated decreased, as did the absolute number of failures and the retreatment failure rate. Development of multidrug resistance has been largely prevented in Nicaragua; the low failure rate justifies the continued use of the standardised retreatment regimen.
Heldal
E
E
National Health Screening Service, Oslo, Norway. eiheldal@online.no
Arnadottir
T
T
Cruz
J R
JR
Tardencilla
A
A
Chacon
L
L
D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D009527:Nicaragua / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011159:Population Surveillance; D015995:Prevalence; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015996:Survival Rate; D017211:Treatment Failure; D014376:Tuberculosis / Q000188:drug therapy / Q000517:prevention & control*; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality
D000995:Antitubercular Agents