Treatment of pulmonary tuberculosis with short course chemotherapy in South India—5-year follow up

Santha, T; Nazareth, O.; Krishnamurthy, Madhuram; Balasubramanian, Ravikumar; Vijayan, V K; Janardhanam, B.; Venkataraman, P; Tripathy, S.P.; Prabhakar, R

doi:10.1016/0041-3879(89)90016-0

Cited by 23 publications

(4 citation statements)

References 2 publications

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“…19 From this finding stemmed the development of modern short-course treatment in a series of clinical trials in East Africa, Hong Kong and Singapore, with a few later studies in Madras, Prague and Algeria. 20 Among the more important findings of this series of trials were 1) the demonstration that there was bactericidal synergism between RMP and PZA, so that both were necessary for the most rapid sterilisation of lesions; 21-23 2) the finding in three trials that RMP was an effective sterilising drug throughout treatment, whereas PZA was only sterilising during the initial intensive phase, 24-26 which was assumed to be due to a change in lesional pH from mildly acidic during acute inflammation to neutral as inflammation died down; 27 and 3) that the initial intensive phase should last 2 months. Treatment regimens with a continuation phase consisting of 4 months of RMP+INH were extensively trialled in Singapore, while those with an alternative continuation phase of 6 months of thioacetazone+INH were trialled in East Africa.…”

Section: The Pastmentioning

confidence: 98%

The chemotherapy of tuberculosis: past, present and future [State of the art]

Mitchison

Davies

2012

int j tuberc lung dis

191

158

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The history of the development of modern chemotherapy for tuberculosis (TB), largely due to the British Medical Research Council, is first described. There is a current need to shorten the duration of treatment and to prevent and cure drug-resistant disease. These aims will only be achieved if the way in which multidrug treatment prevents resistance from emerging and the reasons for the very slow response to chemotherapy are understood. Consideration of mutation rates to resistance and the size of bacterial populations in lesions makes it very unlikely that resistance would emerge spontaneously, leaving irregularity in drug taking and inadequate dosage as the main reasons for its occurrence. Slow response to treatment seems due to the presence of persister populations whose natural history is only partly known. In the future, we need to explore the persister state in patients and in experimental murine TB, and to take it into account in the design of future mouse experiments. The activity of rifamycins and pyrazinamide is being increased by a rise in rifamycin dosage and the inhalation of pyrazinoic acid. New drugs are gradually being brought into use, initially TMC207 and the nitroimadazoles, PA824 and OPC67683. They will need to be tested in new combination regimens for drug-susceptible and multi- and extensively drug-resistant disease.

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Section: The Pastmentioning

confidence: 98%

The chemotherapy of tuberculosis: past, present and future [State of the art]

Mitchison

Davies

2012

int j tuberc lung dis

191

158

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“…[29] After rifampicin was discovered, NIRT conducted many randomized controlled trials in the late 90s which revealed a shorter regimen of 6 months was possible if rifampicin and pyrazinamide were added to the treatment regimen, which further formed the basis of short-course chemotherapy in 1983. [303132] Finally, the Revised National TB Control Program was implemented in pilot areas in 1993 based on the learnings of DOTS and NTP. [3334] Majority but not all of these research work done in the field of TB bear the characteristics of OR and have been the stepping stones toward the ongoing TB program of our country.…”

Section: Operational Research Leading To Policy Changementioning

confidence: 99%

Public health panorama of operational research: A narrative review

Kumar

2019

Int J Prev Med

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Operational research (OR) is a relatively new, applied branch of mathematics, which helps provide a scientific base for the management and problem-solving. At present, its application in public health issues is gaining importance both nationally and internationally, particularly in program management and policy making. It is an interdisciplinary team approach that requires managers and researchers to work together toward identification of the problems and implementation of optimal solutions. There is rising importance accorded by international and national agencies to invest resources in OR and guide program implementation in public health, and the global fund to fight TB, AIDS, and malaria allows up to 10% of each grant to be allocated for OR. There are multitude of research methods used in the field of health. These fields of OR, implementation research, and health system research are a source of confusion for researchers. OR may sometimes be used interchangeably with implementation research or under the subheading of health system research. OR using various qualitative and mathematical models provides solutions which are currently being applied to overcome the obstacles in health policy making and implementation. Integration of OR with monitoring and evaluation is a new paradigm in program management. This paper aims to summarize the theme, relevance, approach, methods, and applications and challenges of OR in the field of public health and how it had led to policy changes in the field of health.

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“…In addition, a 10% relapse rate was observed among isoniazid or streptomycin resistant patients. 28 Eventually, the 1980s studies brought to the recommendations of the International Union Against Tuberculosis and Lung Disease (IUATLD), indicating isoniazid, rifampicin, pyrazinamide for the 2-month induction phase followed by isoniazid and rifampicin for the 4-month continuation phase of the 6-month daily regimen. The same recommendations also indicated adding ethambutol or streptomycin in the initial phase of the three times weekly regimen.…”

Section: Article In Pressmentioning

confidence: 99%

Chemotherapy and diagnosis of tuberculosis

Saltini

2006

Respiratory Medicine

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Since after the first streptomycin 1944 trials, anti-tuberculous chemotherapy research has been focused upon establishing drug combination regimens capable of overcoming drug resistance and amenable to ambulatory treatment in resource strapped countries. The first milestone being the 1959 Madras trial comparing home and sanatorium treatment in South India. Subsequently, the MRC trials led Fox and Mitchison to indicate rifampicin, isoniazid and pyrazinamide as the first line drugs for short course, 6 month, regimens and the 1982 Hong Kong Chest Service trials established intermittent therapy as the ambulatory treatment standard for directly observed therapy (DOT). The rising of the HIV epidemic at the beginning of the 1980s has refuelled tuberculosis spread in Africa and Asia and contributed to the expansion of drug-resistant tuberculosis worldwide making the development of new drugs and drug regimens for ambulatory treatment a top priority. Led by biotechnological advances, molecular biology has been brought into TB laboratory diagnosis for the highly sensitive and specific rapid identification of Mycobacterium tuberculosis in biological samples. The field of immunological diagnosis of TB infection, dominated since the early 1900s by the intradermal tuberculin reaction has been put back in motion by the discovery of M. tuberculosis-specific proteins and peptides, now employed in blood tests of high sensitivity and specificity for the diagnosis of latent TB which may help with the identification of contacts at higher risk of active disease and the eradication of epidemic cases.

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Treatment of pulmonary tuberculosis with short course chemotherapy in South India—5-year follow up

Cited by 23 publications

References 2 publications

The chemotherapy of tuberculosis: past, present and future [State of the art]

The chemotherapy of tuberculosis: past, present and future [State of the art]

Public health panorama of operational research: A narrative review

Chemotherapy and diagnosis of tuberculosis

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