title: [Effects of new discharge criteria incorporating DOTS on treatment outcome of patients with smear-positive tuberculosis].
abstract: BACKGROUND
  Some problems remain in the treatment of tuberculosis (TB) in Japan, with a higher prevalence of TB, low percentages of completed therapy and cases given DOTS, and longer admission period compared to the United States. We defined our own new criteria for discharge as sputum smear negativity instead of culture negativity, modified according to CDC criteria with shortened admission periods. However, the effects on treatment outcome have not been evaluated.
  
  
  OBJECTIVE
  The aim of this study was to ensure the effectiveness of the new criteria, including DOTS undertaken after discharge.
  
  
  METHODS
  Group I comprised 459 cases hospitalized between January 2000 and December 2002 that were discharged under the old criteria, while Group II comprised 259 cases hospitalized between January 2003 and April 2004 that were discharged under the new criteria. We tried to undertake DOTS in cooperation with local health centers. The main outcome measures were admission period, treatment completion and relapse rates at 1 year after the completion of treatment.
  
  
  RESULTS
  The new criteria enabled median admission period to be shortened from 84 days to 69 days, although patients in Group II were older and displayed more severe tuberculosis lesions compared to Group I. DOTS coverage rate increased significantly from 5.9% to 40.5%, and treatment completion rate, percentage of lost cases and relapse rate for completed cases at 1 year changed from 83.0% to 86.6%, 6.3% to 3.9%, and 2.5% to 2.5%, respectively. No significant differences in these 3 rates were noted between Groups I and II.
  
  
  CONCLUSIONS
  The new criteria incorporating DOTS enabled shortened admission period without any adverse effect on treatment outcomes.
authors.affiliation: Department of Respiratory Medicine, International Medical Center of Japan, 1-21-1, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan. eada-iws@cj8.so-net.ne.jp
authors.forename: Eriko
authors.initials: E
authors.lastname: Morino
authors.forename: Takashi
authors.initials: T
authors.lastname: Asakawa
authors.forename: Emiko
authors.initials: E
authors.lastname: Toyota
authors.forename: Naoki
authors.initials: N
authors.lastname: Ishizuka
authors.forename: Gou
authors.initials: G
authors.lastname: Naka
authors.forename: Shinyu
authors.initials: S
authors.lastname: Izumi
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kato
authors.forename: Atsuto
authors.initials: A
authors.lastname: Yoshizawa
authors.forename: Masaaki
authors.initials: M
authors.lastname: Hojo
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Takeda
authors.forename: Akihiko
authors.initials: A
authors.lastname: Kawana
authors.forename: Haruhito
authors.initials: H
authors.lastname: Sugiyama
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kudo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D023801:Directly Observed Therapy; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000592:standards*; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000453:epidemiology