title: Retreatment management strategies when first-line tuberculosis therapy fails.
abstract: METHODS
  Public ambulatory centers in northern Lima, Peru.
  
  
  OBJECTIVE
  To compare two retreatment strategies in Category I failures.
  
  
  METHODS
  Retrospective cohort study of Category I failures enrolled between February 1997 and October 2001. Strategy A was a nationwide approach, applying a Category II regimen; if that regimen failed, a standardized regimen including second-line drugs was used. Strategy B was a pilot protocol designed to diagnose and treat multidrug-resistant tuberculosis (MDR-TB); this strategy included drug susceptibility testing (DST) and eliminated the Category II regimen.
  
  
  RESULTS
  Of 125 patients that Category I failed to cure, 73 entered Strategy A and 52 entered Strategy B. Almost 90% of those with DST results had MDR-TB. Strategy B was three times more likely than Strategy A to cure patients (79% vs. 38%, RR = 2.9, 95% CI 1.7-5.1) and five times more likely to cure patients than the Category II regimen alone (79% vs. 15%, RR 5.2, 95% CI 3.0-9.2). Strategy B also significantly reduced delays to MDR-TB diagnosis and to the initiation of MDR-TB therapy.
  
  
  CONCLUSIONS
  Under program conditions, a retreatment strategy based on DST and eliminating the Category II regimen can improve clinical outcomes among Category I treatment failures found to have active, infectious MDR-TB.
authors.affiliation: National Tuberculosis Control Program, Dirección de Salud III Lima Norte, Lima, Peru.
authors.forename: J C
authors.initials: JC
authors.lastname: Saravia
authors.forename: S C
authors.initials: SC
authors.lastname: Appleton
authors.forename: M L
authors.initials: ML
authors.lastname: Rich
authors.forename: t M
authors.initials: tM
authors.lastname: Sarria
authors.forename: J
authors.initials: J
authors.lastname: Bayona
authors.forename: M C
authors.initials: MC
authors.lastname: Becerra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000008:administration & dosage; D002648:Child; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010865:Pilot Projects; D012189:Retrospective Studies; D017211:Treatment Failure; D014376:Tuberculosis / Q000188:drug therapy*; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy
chemical_list: D000995:Antitubercular Agents