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System for Efficacy and Cytotoxicity Screening of Inhibitors Targeting Intracellular Mycobacterium tuberculosis
Published on: April 5, 2017
Terapia de tuberculosis de primera línea y Mycobacterium tuberculosis resistente a los medicamentos en las prisiones
R Coninx1, C Mathieu, M Debacker
1International Committee of the Red Cross, Geneva, Switzerland. rconinx@icrc.org
Lancet (London, England)
|August 25, 1999
Resumen
El control de la tuberculosis en una prisión de Bakú utilizando tratamiento de observación directa, curso corto (DOTS) y terapia de primera línea logró una tasa de éxito del 54%. Las altas tasas de resistencia a los medicamentos y la no finalización del tratamiento contribuyeron a resultados por debajo de los objetivos de la OMS.
Área de la Ciencia:
- Salud Pública La salud pública.
- Enfermedades infecciosas Enfermedades infecciosas.
- La medicina clínica es la medicina clínica.
Sus antecedentes:
- Evaluó un programa de control de la tuberculosis en una prisión de Bakú, Azerbaiyán.
- Utilizó la terapia de primera línea y el tratamiento directamente observado, curso corto (DOTS).
Objetivo del estudio:
- Evaluar la efectividad de un programa DOTS para el control de la tuberculosis en un entorno de alta resistencia.
- Identificar los factores asociados con el fracaso del tratamiento.
Principales métodos:
- Se estudió a 467 pacientes con tuberculosis positiva para el esputo.
- Regímenes de tratamiento monitoreados según las directrices de la OMS, incluidos exámenes clínicos y suplementos.
- aislados probados para la resistencia a los fármacos (isoniazida, rifampicina, etambutol, estreptomicina).
- El éxito del tratamiento se define como tres frotis de esputo consecutivos negativos.
- Utilizó regresión logística para identificar factores relacionados con el fracaso del tratamiento.
Principales resultados:
- El 55% de los pacientes analizados tenían Mycobacterium tuberculosis resistente a dos o más antibióticos.
- El éxito del tratamiento fue del 54% en general y del 71% entre los que completaron el tratamiento.
- La mortalidad fue del 11%, y el 13% de los pacientes fallaron.
- El fracaso del tratamiento se asoció con resistencia a múltiples fármacos, esputo positivo después del tratamiento, enfermedad cavitaria y mal cumplimiento.
Conclusiones:
- La efectividad del programa DOTS (54%) no alcanzó el objetivo de la OMS (85%).
- La terapia de primera línea puede ser insuficiente en áreas con alta resistencia a los antibióticos.
- Los establecimientos penitenciarios requieren estrategias personalizadas para combatir eficazmente la tuberculosis.
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