González Claudio, Sáenz César, Herrmann Eduardo, Jajati Mónica, Kaplan Paula, Monzón Dora
Unidad Neumotisiología, Hospital J.M. Ramos Mejía, Buenos Aires, Argentina.
Medicina (B Aires). 2012;72(5):371-9.
The outcomes of directly observed therapy of tuberculosis (DOT) between 1/1/1979 and 12/31/2009 were analyzed. Results obtained in the 1979-1999 period were compared with those achieved in the 2000-2009 period. In a Buenos Aires City hospital, 582 HIV negative TB patients received rifampin, isoniazid, pyrazinamide and ethambutol or streptomycin in the initial stage, followed by a second stage where patients were included in two groups: G1 composed by 424 patients (period 1/1/1979-12/31/1999) who received either rifampin and isoniazid or rifampin and streptomicin twice a week, and G2, with 158 patients (period 1/1/2000-12/31/2009) who received either rifampin and isoniazid twice or three times a week. National and Buenos Aires City TB Control Programs recommendations were followed. Patients who underwent DOT had higher completeness rates than those included in self-administered therapy (82.8% vs. 48.7%), (p <0.0001). Mean age: 36.3 ± 15.3 years, males: 63.1% and 69.4% were Argentine citizens. A 8.9% had been previously treated, 6.1% had co-morbidities. A 70.6% of pulmonary cases was bacteriologically confirmed, 82.8% of them completed the treatment, while 11.5% defaulted. Adverse effects to antituberculosis drugs were observed in 9.5% of cases; male patients showed higher rates of non adherence. G2 had a lower proportion of native people (48.7% vs. 77.1%), (p = 0.0001), higher frequency of co-morbidities (10.7% vs. 4.4%), (p = 0.005), of bacteriologically confirmed pulmonary cases (95% vs. 87%), (p = 0.02) and more adverse effects than G1 (17% vs. 6.6%), (p = 0.0001). In coincidence with other experiences, this work shows high treatment success rates in patients treated under DOT strategy.
分析了1979年1月1日至2009年12月31日期间结核病直接督导治疗（DOT）的结果。将1979 - 1999年期间获得的结果与2000 - 2009年期间取得的结果进行了比较。在布宜诺斯艾利斯市的一家医院，582例HIV阴性的结核病患者在初始阶段接受了利福平、异烟肼、吡嗪酰胺和乙胺丁醇或链霉素治疗，随后进入第二阶段，患者被分为两组：G1组由424例患者组成（1979年1月1日至1999年12月31日期间），他们每周接受两次利福平和异烟肼或利福平和链霉素治疗；G2组有158例患者（2000年1月1日至2009年12月31日期间），他们每周接受两次或三次利福平和异烟肼治疗。遵循了国家和布宜诺斯艾利斯市结核病控制项目的建议。接受DOT治疗的患者的完成率高于自我给药治疗的患者（82.8%对48.7%），（p<0.0001）。平均年龄：36.3±15.3岁，男性：63.1%，69.4%为阿根廷公民。8.9%的患者曾接受过治疗，6.1%有合并症。70.6%的肺部病例经细菌学确诊，其中82.8%完成了治疗，而11.5%中断治疗。9.5%的病例观察到对抗结核药物有不良反应；男性患者的不依从率较高。G2组中本地人比例较低（48.7%对77.1%），（p = 0.0001），合并症发生率较高（10.7%对4.4%），（p = 0.005），细菌学确诊的肺部病例发生率较高（95%对87%），（p = 0.02），且不良反应比G1组更多（17%对6.6%），（p = 0.0001）。与其他经验一致，这项工作表明在DOT策略下治疗的患者有较高的治疗成功率。
