Saravia J C, Appleton S C, Rich M L, Sarria t M, Bayona J, Becerra M C
National Tuberculosis Control Program, Dirección de Salud III Lima Norte, Lima, Peru.
Int J Tuberc Lung Dis. 2005 Apr;9(4):421-9.
Public ambulatory centers in northern Lima, Peru.
To compare two retreatment strategies in Category I failures.
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.
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.
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.
秘鲁利马北部的公共门诊中心。
比较I类治疗失败的两种再治疗策略。
对1997年2月至2001年10月期间登记的I类治疗失败患者进行回顾性队列研究。策略A是一种全国性方法，采用II类治疗方案；如果该方案失败，则使用包括二线药物的标准化方案。策略B是一项旨在诊断和治疗耐多药结核病（MDR-TB）的试点方案；该策略包括药敏试验（DST）并取消了II类治疗方案。
在125例I类治疗未治愈的患者中，73例采用策略A，52例采用策略B。几乎90%有药敏试验结果的患者患有耐多药结核病。策略B治愈患者的可能性是策略A的三倍（79%对38%，RR = 2.9，95% CI 1.7 - 5.1），比单独使用II类治疗方案治愈患者的可能性高五倍（79%对15%，RR 5.2，95% CI 3.0 - 9.2）。策略B还显著减少了耐多药结核病诊断和耐多药结核病治疗开始的延迟。
在项目条件下，基于药敏试验并取消II类治疗方案的再治疗策略可改善在确诊为活动性、传染性耐多药结核病的I类治疗失败患者中的临床结局。
