Interventions for Tuberculosis Control and Elimination 2002
Interventions for Tuberculosis Control and Elimination 2002
Interventions for Tuberculosis Control and Elimination 2002
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ment regimen is efficacious <strong>and</strong> not causing drug resistance in HIV-infected<br />
patients remains to be seen. 598<br />
Influence of isoniazid plus rifampicin resistance<br />
on the choice of a regimen<br />
Patients with multidrug-resistant tuberculosis (bacilli resistant to at least isoniazid<br />
<strong>and</strong> rifampicin) are only rarely expected to be cured solely using the<br />
six essential drugs. Under program conditions treatment outcome with the<br />
st<strong>and</strong>ard WHO recommended re-treatment regimen is poor if there is multidrug<br />
resistance. 605 Barring spontaneous remission, such patients are incurable<br />
<strong>and</strong> frequently become chronic excretors of bacilli in countries where<br />
only the essential drugs are available <strong>for</strong> use.<br />
Drugs other than the six essential drugs are of lower efficacy, much<br />
more costly, <strong>and</strong> in the majority of cases, much less well tolerated. 606-608<br />
It is also not yet known which treatment strategy is best. Proposals <strong>for</strong><br />
treating multidrug-resistant tuberculosis include the utilization of a st<strong>and</strong>ard<br />
regimen or an individualized approach based on susceptibility testing. 609<br />
There have been no r<strong>and</strong>omized controlled clinical trials to evaluate these<br />
regimens <strong>and</strong> insufficient experience has been accumulated to make firm<br />
recommendations at this point in time.<br />
Strategic considerations, indications,<br />
<strong>and</strong> recommendations <strong>for</strong> the choice of treatment<br />
regimens in a national tuberculosis control program<br />
The number of possible errors can be minimized by the systematic, country-wide<br />
use of st<strong>and</strong>ard regimens. Recommended st<strong>and</strong>ard treatment regimens<br />
are based on clinical efficacy trials in terms of dosage, mode of<br />
administration, <strong>and</strong> duration of treatment. Deviations from st<strong>and</strong>ard treatment<br />
regimens are indicated only in the case of adverse drug events, <strong>for</strong><br />
patients presenting with pre-existing medical conditions that require a modification<br />
of the regimen, or in the presence of suspected or confirmed resistance<br />
to one or more drugs.<br />
Both WHO <strong>and</strong> the IUATLD recommend st<strong>and</strong>ard treatment regimens<br />
which vary according to the category of the patient. 13 The three categories<br />
are: 8<br />
78
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