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Tuberculosis in Kentucky: current recommendations for empiric therapy
1Division of Infectious Diseases, University of Louisville School of Medicine, Louisville, KY 40292, USA.
The Journal of the Kentucky Medical Association
|March 1, 1997
Summary
Tuberculosis drug resistance is increasing in Kentucky, with higher rates of isoniazid resistance in certain counties. This necessitates tailored empiric therapy strategies based on local resistance patterns to effectively treat pulmonary tuberculosis.
Area of Science:
- Public Health
- Infectious Diseases
- Microbiology
Background:
- Current tuberculosis treatment guidelines rely on community resistance patterns of isoniazid (INH) and rifampin.
- Understanding local drug resistance is crucial for effective empiric tuberculosis therapy.
Purpose of the Study:
- To determine the drug susceptibility patterns of Mycobacterium tuberculosis (MTB) in Kentucky.
- To inform appropriate empiric therapy strategies for pulmonary tuberculosis based on resistance data.
Main Methods:
- Analysis of pulmonary tuberculosis case numbers and national trends in Kentucky (1984-1994).
- Evaluation of drug susceptibility data for INH and rifampin resistance from 1989-1994.
- Geographic mapping of INH resistance rates across Kentucky counties.
Main Results:
- A 14% decrease in MTB cases was observed in 1994, but INH resistance doubled from 3.2% to 7.6%.
- Multidrug-resistant tuberculosis (MDRTB) increased from 1.2% to 3.2%, with an outbreak in Estill County.
- Counties with >4% INH resistance required 4-drug empiric therapy; Estill County (MDRTB) required 5-6 drugs.
Conclusions:
- Empiric tuberculosis therapy in Kentucky needs to be adjusted based on county-specific INH resistance levels.
- Higher resistance rates necessitate broader drug regimens, including PZA, ethambutol, or streptomycin.
- Individualized treatment is essential for MDRTB, especially in areas with documented outbreaks.