Hospital Sanatório Partenon, Rio Grande do Sul State Health Department, Porto Alegre, Brazil.
J Bras Pneumol. 2011 Jul-Aug;37(4):504-11. doi: 10.1590/s1806-37132011000400013.
To describe the outcomes of retreatment in tuberculosis patients receiving the regimen known, in Brazil, as regimen 3 (streptomycin, ethambutol, ethionamide, and pyrazinamide for 3 months + ethambutol and ethionamide for 9 months) after treatment failure with the basic regimen (rifampin, isoniazid, and pyrazinamide for 2 months + rifampin and isoniazid for 4 months).
A descriptive, uncontrolled, historical cohort study involving adult tuberculosis patients treated with regimen 3. We evaluated adverse drug effects, recurrence, treatment outcomes, and associated factors.
The study included 229 patients. The overall cure rate was 62%. For the patients who used the medications regularly and those who did not, the cure rate was 88% and 31%, respectively. Adverse events occurred in 95 patients (41.5%), and most of those events were related to the gastrointestinal tract. In the five-year follow-up period, relapse occurred in 17 cases (12.0%).
Overall, the outcomes of treatment with regimen 3 were unsatisfactory, in part because this regimen was administered to a selected population of patients at high risk for noncompliance with treatment, as well as because it presents high rates of adverse effects, especially those related to the gastrointestinal tract, which might be caused by ethionamide. However, for those who took the medications regularly, the cure rate was satisfactory. The recurrence rate was higher than that recommended in international consensus guidelines, which might be attributable to the short (12-month) treatment period. We believe that regimen 3, extended to 18 months, represents an option for patients with proven treatment compliance.
描述在巴西被称为方案 3（链霉素、乙胺丁醇、乙硫异烟胺和吡嗪酰胺治疗 3 个月+乙胺丁醇和乙硫异烟胺治疗 9 个月）的方案治疗治疗失败后的结核患者（利福平、异烟肼和吡嗪酰胺治疗 2 个月+利福平和异烟肼治疗 4 个月）的再治疗结果。
一项描述性、非对照、历史性队列研究，涉及接受方案 3 治疗的成年结核病患者。我们评估了药物不良反应、复发、治疗结果和相关因素。
该研究纳入了 229 名患者。总治愈率为 62%。对于规律用药的患者和不规律用药的患者，治愈率分别为 88%和 31%。95 名患者（41.5%）发生了不良事件，其中大多数与胃肠道有关。在五年随访期间，17 例（12.0%）复发。
总体而言，方案 3 的治疗结果不尽如人意，部分原因是该方案被用于治疗依从性差的高危患者人群，并且该方案还存在高不良反应率，尤其是胃肠道相关的不良反应，这可能是由乙硫异烟胺引起的。然而，对于那些规律用药的患者，治愈率令人满意。复发率高于国际共识指南推荐的水平，这可能归因于治疗时间较短（12 个月）。我们认为，延长至 18 个月的方案 3 是一种治疗已证明具有治疗依从性的患者的选择。
