刑務所での第一線結核治療と薬剤耐性Mycobacterium tuberculosisの治療について

R Coninx¹, C Mathieu, M Debacker

¹International Committee of the Red Cross, Geneva, Switzerland. rconinx@icrc.org

Lancet (London, England)

|August 25, 1999

まとめ

直接観察治療,短期間治療 (DOTS) と第一線治療を用いたバクー刑務所での結核の制御は,54%の成功率を達成しました. 薬剤耐性の高い割合と治療の未完了は,WHOの目標を下回る結果につながった.

科学分野:

公衆衛生は公衆衛生である.
感染症感染症は感染症です.
クリニカル・メディシン臨床医学

背景:

アゼルバイジャンのバクウにある刑務所で結核対策プログラムを評価した.
ファーストライン療法と直接観察治療,短期コース (DOTS) を利用しました.

研究の目的:

高耐性環境における結核の制御のためのDOTSプログラムの有効性を評価する.
治療の失敗に関連する要因を特定する.

主な方法:

唾液陽性結核の467人の患者を研究した.
臨床試験とサプリメントを含むWHOのガイドラインによるモニタリングされた治療レジメン.
薬剤耐性に対する試験された単離物 (イソニアジド,リファンピシン,エタムボトル,ストレプトマイシン).
治療の成功は,連続して3回のネガティブな唾液のスプレーとして定義されます.
治療失敗に関連する要因を特定するために,ロジスティック回帰を使用しました.

主要な成果:

検査された患者の55%は,2つ以上の抗生物質に耐性のあるMycobacterium tuberculosisを患っていた.
治療の成功率は全体で54%で,治療を終えた患者では71%でした.
死亡率は11%で,患者の13%がデフォルトしました.
治療の失敗は,多剤耐性,治療後のプラスの唾液,穴腔疾患,および従順性の低下と関連していました.

結論:

DOTSプログラムの有効性 (54%) はWHOの目標 (85%) に満たなかった.
抗生物質耐性が高い地域では,ファーストライン療法が不十分である可能性があります.
刑務所の環境では,結核と効果的に闘うために,個別化された戦略が必要です.

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