Community-based Short-Course Treatment of Pulmonary Tuberculosis in a Developing Nation: Initial Report of an Eight-Month, Largely Intermittent Regimen in a Population with a High Prevalence of Drug Resistance

Abstract

A community-based tuberculosis case-finding and short-course chemotherapy program was conducted in a suburb of Manila and featured 1 month of daily isoniazid (INH), rifampin (RIF), ethambutol (EMB), and pyrazinamide (PZA) followed by 7 months of twice-weekly, high dose, directly observed INH + EMB + PZA. Church-affiliated lay workers obtained 1,990 sputum specimens from subjects who complained of chronic cough or wasting symptoms; 207 of the specimens were positive on Ziehl-Neelsen smears. On culture, 176 yielded a significant growth of M. tuberculosis. Of these 176 patients, 144 were selected to enter the study; 10 were lost because of withdrawal or death and four (2.7%) because of drug toxicity. This left 130 patients who were followed long-term. Remarkably, 80% (104) were initially shedding drug-resistant organisms; 26% (34) were resistant to one drug, 30% (40) were resistant to two drugs, and 24% (30) were resistant to three or more drugs. Responses to therapy corresponded closely to the extent of drug resistance: 80% (48 of 60) of patients with drug-susceptible or single resistance had a favorable outcome; 43% (28 of 65) were resistant to two or three drugs, and 0% (0 of 5) of those were resistant to four or more drugs. Notable findings of this study were the success of a community-based program in conducting prolonged, directly observed treatment, the unexpectedly high prevalence of multiple-drug-resistant organisms in this population, and the inadequacy of INH + PZA + EMB during the continuation phase of therapy in this setting.

TB case-finding in southern Ethiopia

“…[10][11][12] However, in areas with high TB incidence, the principal source of infection may be contacts outside the household, 13,14 thus a broader perspective is needed to improve case-finding in such communities. 15 In Ethiopia, which ranks 7th of 22 countries with a high burden of TB, 16 many patients live far from health facilities and usually present very late for investigation and treatment. 7 The…”

“…29 A similar achievement was reported from the Philippines. 15 However, no data have so far been published on the effect of such interventions on pre-treatment symptom duration. In the 1960s and 1970s, periodic symptomatic case-screening and use of mass, miniature radiography as means of active case-finding were reported to be less effective than expected in middleand high-income settings.…”

The benefits to communities and individuals of screening for active tuberculosis disease: a systematic review [State of the art series. Case finding/screening. Number 2 in the series]

“…In this paper, 69 we will use "screening" to describe ACF interventions and ECF for interventions that mainly focus on 70 health information. 71 …”

Primary Drug Resistance of <i>Mycobacterium tuberculosis </i>to First Line Antitubercular Agents at Kuwait Chest Diseases Hospital during 1992–1995

“…It is not surprising for us to find a higher rate of multiple drug resistance in the non-Kuwaiti patients. Multiple drug resistance is a major public health problem in countries like Pakistan [14], India [15,16], Bangladesh [17] and Philippines [27], from where the expatriates originate.…”

“…However, this may not be the case, because two thirds of the Kuwaiti population is composed of nonKuwaiti expatriate work-force. These workers originate from countries with high incidence of tuberculosis and high resistance rates [14][15][16][17]27]. Although all the foreign workers are screened for PTB in their native countries and in Kuwait, some cases of inactive PTB may escape radiologic detection.…”