[Effects of new discharge criteria incorporating DOTS on treatment outcome of patients with smear-positive tuberculosis].
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.
Morino
Eriko
E
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
Asakawa
Takashi
T
Toyota
Emiko
E
Ishizuka
Naoki
N
Naka
Gou
G
Izumi
Shinyu
S
Kato
Yasuyuki
Y
Yoshizawa
Atsuto
A
Hojo
Masaaki
M
Takeda
Yuichiro
Y
Kawana
Akihiko
A
Sugiyama
Haruhito
H
Kobayashi
Nobuyuki
N
Kudo
Koichiro
K
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