Caminero J A, Pavón J M, Rodríguez de Castro F, Díaz F, Julià G, Caylá J A, Cabrera P
Hospital Ntra. Sra. del Pino, Universidad de Las Palmas de Gran Canaria, Spain.
Thorax. 1996 Nov;51(11):1130-3. doi: 10.1136/thx.51.11.1130.
Although a priority for tuberculosis control is to achieve the maximum cure rate, compliance with chemotherapy in specific high risk groups (homeless, intravenous drug abusers, chronic alcoholics) is usually poor.
From January 1990 to December 1994 102 patients with tuberculosis (96 pulmonary, six extrapulmonary) who were poorly compliant with treatment were treated with a six month fully intermittent (twice weekly) directly observed regimen. They comprised 71 homeless subjects, 50 chronic alcoholics, 23 intravenous drug abusers, nine infected with HIV, and 11 who had previously abandoned a daily antituberculosis regimen; 53 had more than one of these risk factors. Treatment included isoniazid and rifampicin for six months and pyrazinamide during the first two months. Patients who failed to take their medication on two consecutive occasions were actively sought by telephone or by personal search.
After two months of treatment 95 of the 102 patients had taken their medication regularly and 90 of them had negative cultures. Four of the remaining patients had negative cultures after three months. At the end of the six months 87 patients had completed treatment and were considered cured. Only 15 patients abandoned the treatment (13 of whom had more than one risk factor). Only three relapses occurred in the 102 patients at one year follow up and in the 88 patients followed for two years. Two patients required a change of treatment due to major side effects. Although intravenous drug abuse was the only predictor of non-compliance in the multivariate analysis, if the available variables in the second month of treatment were analysed, current poor compliance and abandonment of treatment in the past were found to be significantly associated with non-compliance.
This study shows the efficacy of this intermittent regimen and the effectiveness of a directly observed treatment programme.
尽管结核病控制的一个首要目标是实现最高治愈率，但特定高危人群（无家可归者、静脉吸毒者、慢性酗酒者）对化疗的依从性通常较差。
1990年1月至1994年12月，对102例治疗依从性差的结核病患者（96例肺部结核，6例肺外结核）采用为期6个月的全间歇（每周两次）直接观察治疗方案。其中包括71名无家可归者、50名慢性酗酒者、23名静脉吸毒者、9名感染艾滋病毒者以及11名此前放弃每日抗结核治疗方案的患者；53人存在不止一种上述危险因素。治疗包括使用异烟肼和利福平治疗6个月，头两个月加用吡嗪酰胺。对于连续两次未服药的患者，通过电话或亲自寻找积极追踪。
治疗两个月后，102例患者中有95例规律服药，其中90例培养结果为阴性。其余患者中有4例在三个月后培养结果为阴性。6个月末，87例患者完成治疗并被视为治愈。仅15例患者放弃治疗（其中13例存在不止一种危险因素）。在102例患者一年随访以及88例患者两年随访中，仅发生3例复发。两名患者因严重副作用需要更换治疗方案。尽管在多变量分析中静脉吸毒是不依从的唯一预测因素，但如果分析治疗第二个月时可用变量，发现当前依从性差和过去放弃治疗与不依从显著相关。
本研究显示了这种间歇治疗方案的疗效以及直接观察治疗项目的有效性。
