Six- vs. eight-month anti-tuberculosis regimen for pulmonary tuberculosis under programme conditions.

SETTING

One urban tertiary care and one rural secondary care hospital in Nigeria.

OBJECTIVE

To compare the epidemiological characteristics and treatment outcomes of tuberculosis (TB) patients treated with an 8-month or 6-month anti-tuberculosis regimen in a low-resource setting.

DESIGN

Retrospective cohort study.

RESULTS

A total of 928 newly diagnosed smear-positive TB patients were treated with either daily ethambutol (EMB), isoniazid (INH), rifampicin (RMP) and pyrazinamide (PZA) for 2 months followed by EMB and INH for 6 months (2RHZE/6EH), or the same intensive phase as the first regimen followed by 4 months of daily RMP and INH (2RHZE/4RH). The proportion of successful outcomes was 381/490 (77.8%) with 2RHZE/6EH and 373/438 (85.2%) with 2RHZE/4RH (P = 0.004). Defaulting was significantly more frequent in patients who received 2RHZE/6EH (14.3% vs. 5.5%; P < 0.001). Treatment failure was not significantly higher in patients who received 2RHZE/6EH (2.9% vs. 1.6%; P = 0.15). After adjusting for confounders, older age (adjusted odds ratio [aOR] 1.7), 2RHZE/6EH treatment (aOR 1.6) and male sex (aOR 1.5) independently predicted unsuccessful outcomes in human immunodeficiency virus negative TB patients.

CONCLUSIONS

Newly diagnosed TB patients on 2RHZE/4RH have a higher treatment success rate than those treated with 2RHZE/6EH under programme conditions in a low-resource, high-burden setting. Current World Health Organization recommendations should be maintained.