Desfechos do retratamento de pacientes com tuberculose com o uso do esquema 3 em Porto Alegre, Brasil

Abstract

Objective: 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). Methods: 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. Results: 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%). Conclusions: 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.Keywords: Tuberculosis, pulmonary/therapy; Treatment outcome; Retreatment. ResumoObjetivo: Descrever os desfechos do retratamento de pacientes com tuberculose com o uso do esquema 3 (estreptomicina, etambutol, etionamida e pirazinamida por 3 meses + etambutol e etionamida por 9 meses) devido à falência do tratamento com o esquema básico (rifampicina, isoniazida e pirazinamida por 2 meses + rifampicina e isoniazida por 4 meses). Métodos: Estudo descritivo de coorte histórica, não controlada, com adultos que foram tratados com o esquema 3. Foram avaliados os desfechos desse tratamento, as reações adversas aos fármacos, as recidivas e os fatores associados. Resultados: Foram incluídos no estudo 229 pacientes. A taxa de cura geral foi de 62%. Entre os pacientes que usaram a medicação regularmente e aqueles que a usaram irregularmente, a taxa de cura foi de 88% e 31%, respectivamente. Observaram-se reações adversas em 95 pacientes (41,5%), principalmente digestivas. Ocorreram 17 recidivas (12,0%) nos cinco anos de seguimento. Conclusões: Os desfechos com o uso do esquema 3, em geral, não foram satisfatórios, pois esse esquema foi aplicado em uma população selecionada com alto risco de não adesão ao tratamento e apresenta altas taxas de reações adversas, especialmente as de tipo digestivo, possivelmente causadas pela etionamida....

Desfecho dos casos de tuberculose em pessoas com HIV: subsídios para intervenção

“…This result resumes the question of non-compliance to treatment, which can be attributed to several aspects: psychosocial, economic, lack of attachment to the team, drug toxicity, side effects and/or alcoholism and drug addiction, also identified in other studies in the country. (36) Regarding compliance to treatment as a sine qua non aspect to obtain better results, it is important to point out that drug toxicity and drug interactions contribute substantially to non-compliance to treatment, emphasizing the need for special care in follow-up of individuals. (35) Authors also point out characteristics related to previous TB treatments and TB-HIV co-infection itself as aspects related to TB mortality.…”