The Effect of Directly Observed Therapy on the Rates of Drug Resistance and Relapse in Tuberculosis

Weis, Stephen E.; Slocum, Philip; Blais, Francis X.; King, Bonnie S; Nunn, Mary; Matney, G B; Gomez, Evaristo; Foresman, BH

doi:10.1056/nejm199404283301702

Cited by 524 publications

(255 citation statements)

References 26 publications

Supporting

Mentioning

236

Contrasting

Unclassified

Order By: Relevance

“…Strengthening DOTS programmes was credited with stopping the outbreaks of MDR tuberculosis in many regions in the USA, especially in New York City, the Dallas-Fort Worth Metroplex, and Baltimore. [161][162][163][164] Emergence of acquired drug resistance eventually became equated with poor adherence, and high rates of acquired drug resistance were considered to be an indicator of poor performance of DOTS programmes. Thus, high numbers of patients defaulting from therapy is now considered an indicator of poor treatment outcomes in its own right, as bad as therapy failure.…”

Section: The Rise Of Drug-resistant Tuberculosis Historical Notions Omentioning

confidence: 99%

“…155,164,185 These were the only type of studies available and thus represented the best available evidence at the time. Since then, at least five randomised controlled trials and five prospective observational studies, in which patients were assigned to self-administered therapy or supervised therapy (ie, DOTS), have been reported.…”

Section: The Rise Of Drug-resistant Tuberculosis Historical Notions Omentioning

confidence: 99%

See 1 more Smart Citation

The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis

Dheda

Gumbo

Maartens

et al. 2017

The Lancet Respiratory Medicine

506

474

View full text Add to dashboard Cite

Section: The Rise Of Drug-resistant Tuberculosis Historical Notions Omentioning

confidence: 99%

Section: The Rise Of Drug-resistant Tuberculosis Historical Notions Omentioning

confidence: 99%

The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis

Dheda

Gumbo

Maartens

et al. 2017

The Lancet Respiratory Medicine

506

474

View full text Add to dashboard Cite

“…[23][24][25] All 43 identified source cases were family members, caregivers, or household members. Shortening their infectious periods may have prevented transmission to children.…”

Section: Ofmentioning

confidence: 99%

Missed Opportunities for Preventing Tuberculosis Among Children Younger Than Five Years of Age

2000

View full text Add to dashboard Cite

ABSTRACT. Objectives. Childhood tuberculosis (TB)is an important indicator of public health success in interrupting and preventing TB transmission. To determine the frequency and types of missed opportunities for preventing TB among children <5 years of age.Methods. We collected data from the public health records of child TB cases and their adult source cases. These children were from health jurisdictions where TB case rates in children were higher than the California average for this age group.Results. We reviewed the records for 165 children reported with TB (20% confirmed by culture). These children were evaluated for TB because of signs or symptoms of illness (32%), a contact investigation (26%), screening (22%), a source case investigation (4%), and unknown reasons (16%). Excluding 4 children infected by Mycobacterium bovis, only 59 of 161 children (37%) had a source case found. Children found in a contact investigation, born in the United States, <1 year of age, or who were black were more likely to have a source case found than children who did not have one of these characteristics. Of 43 children found in a contact investigation, improvements in contact investigations may have prevented TB in 17 of these children (40%). Among the 43 adult source cases, factors that may have facilitated transmission include delayed reporting in 23%, a delayed contact investigation in 21%, and delayed or nondocumented bacteriologic sputum conversion in 42% of culture-positive cases.Conclusions. Important missed opportunities to prevent TB in children include the failure to find and appropriately manage adult source cases and failure to completely evaluate and properly treat children exposed to TB. Improvements in case detection, case management, and contact investigations are necessary to eliminate TB in children. Pediatrics 2000;106(6). URL: http://www. pediatrics.org/cgi/content/full/106/6/e75; tuberculosis, children, prevention, missed opportunities.ABBREVIATIONS. TB, tuberculosis; TST, tuberculin skin test; RR, relative risk; CI, confidence interval; INH, isoniazid. D espite recent declines in the incidence of tuberculosis (TB) in the United States, TB continues to be an important health problem in specific social and racial groups. As public health agencies increasingly focus on strategies to eliminate TB in the United States, 1 childhood TB becomes an important indicator of program success in interrupting and preventing recent TB transmission. TB cases among children indicate recent transmission of Mycobacterium tuberculosis usually from an infectious adult, often a family or household member, 2,3 and are a sensitive indicator of deficiencies in efforts to prevent TB transmission. The mainstays of TB prevention in children are the timely diagnosis, reporting, and curative treatment of adults with TB disease so that the transmission of M tuberculosis is interrupted. 4,5 In addition, children exposed to infectious cases need a thorough medical evaluation and, if TB disease is excluded, prompt initiation of treatment f...

show abstract

“…3 The preferred mechanism of therapy for both inpatients and outpatients is DOT. 113,114 Treatment of patients with active TB is the top public health priority for TB control, followed by contact investigation of all persons who came into close contact with these patients before initiation of therapy. Such contact investigation should be carried out on all patients with confirmed active pulmonary TB and on selected patients with suspected pulmonary TB before testing is complete.…”

Section: Control and Eliminationmentioning

confidence: 99%

Current Concepts in the Management of Tuberculosis

Sia

Wieland

2011

Mayo Clinic Proceedings

154

108

View full text Add to dashboard Cite

E ffective medical therapy for tuberculosis (TB) has existed for more than half a century, yet TB remains among the most pressing public health issues of our day. Tuberculosis is, in part, a disease of poverty. 1 The fact that it remains the eighth leading cause of death in the world speaks to the challenges facing practitioners and public health officials as they try to control a disease that is so entwined in the cultural and economic fabric of society. Challenges to effective solutions include lack of access to diagnosis and treatment, the frequent coexistence of epidemics of TB and human immunodeficiency virus (HIV), and the Tuberculosis (TB) poses a serious threat to public health throughout the world but disproportionately afflicts low-income nations. Persons in close contact with a patient with active pulmonary TB and those from endemic regions of the world are at highest risk of primary infection, whereas patients with compromised immune systems are at highest risk of reactivation of latent TB infection (LTBI). Tuberculosis can affect any organ system. Clinical manifestations vary accordingly but often include fever, night sweats, and weight loss. Positive results on either a tuberculin skin test or an interferon-γ release assay in the absence of active TB establish a diagnosis of LTBI. A combination of epidemiological, clinical, radiographic, microbiological, and histopathologic features is used to establish the diagnosis of active TB. Patients with suspected active pulmonary TB should submit 3 sputum specimens for acidfast bacilli smears and culture, with nucleic acid amplification testing performed on at least 1 specimen. For patients with LTBI, treatment with isoniazid for 9 months is preferred. Patients with active TB should be treated with multiple agents to achieve bacterial clearance, to reduce the risk of transmission, and to prevent the emergence of drug resistance. Directly observed therapy is recommended for the treatment of active TB. Health care professionals should collaborate, when possible, with local and state public health departments to care for patients with TB. Patients with drug-resistant TB or coinfection with human immunodeficiency virus should be treated in collaboration with TB specialists. Public health measures to prevent the spread of TB include appropriate respiratory isolation of patients with active pulmonary TB, contact investigation, and reduction of the LTBI burden. Proc. 2011;86(4):348-361 AFB = acid-fast bacilli; BCG = bacille Calmette-Guérin; CFP-10 = culture filtrate protein 10; DOT = directly observed therapy; EMB = ethambutol; ESAT-6 = early-secreted antigenic target 6; HIV = human immuno deficiency virus; IFN-γ = interferon-γ; IGRA = IFN-γ release assay; INH = isoniazid; LTBI = latent TBI; MDR-TB = multidrug-resistant TB; NAA = nucleic acid amplification; PZA = pyrazinamide; RIF = rifampin; TB = tuberculosis; TBI = TB infection; TST = tuberculin skin test; XDR-TB = extensively drug-resistant TB Mayo Clin

show abstract

The Effect of Directly Observed Therapy on the Rates of Drug Resistance and Relapse in Tuberculosis

Abstract: The administration of therapy for M. tuberculosis infection under direct observation leads to significant reductions in the frequency of primary drug resistance, acquired drug resistance, and relapse.

Cited by 524 publications

References 26 publications

The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis

The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis

Missed Opportunities for Preventing Tuberculosis Among Children Younger Than Five Years of Age

Current Concepts in the Management of Tuberculosis

Contact Info

Product

Resources

About