第一线结核病治疗和监狱中的耐药Mycobacterium结核病
R Coninx1, C Mathieu, M Debacker
1International Committee of the Red Cross, Geneva, Switzerland. rconinx@icrc.org
Lancet (London, England)
|August 25, 1999
概括
在巴库监狱使用直接观察治疗,短疗程 (DOTS) 和一线治疗来控制结核病的成功率达到了54%. 药物耐药性和治疗未完成率高,导致治疗结果低于世卫组织的目标.
科学领域:
- 公共卫生 公共卫生
- 传染性疾病 传染性疾病
- 临床医学 临床医学
背景情况:
- 评估了阿塞拜疆巴库一所监狱的结核控制计划.
- 使用了第一线治疗和直接观察治疗,短期疗程 (DOTS).
研究的目的:
- 评估DOTS计划在高抗性环境下对结核病控制的有效性.
- 确定与治疗失败相关的因素.
主要方法:
- 研究了467名唾液阳性结核病患者.
- 按照世卫组织指导方针监测治疗方案,包括临床检查和补充.
- 对耐药性进行测试的分离物 (伊索尼亚齐德,利芬素,乙墨托醇,斯特雷普托米辛).
- 治疗成功的定义是连续三次阴性唾液涂抹.
- 使用后勤回归来识别与治疗失败相关的因素.
主要成果:
- 55%的测试患者患有耐两种或更多抗生素的结核菌菌.
- 总体而言,治疗成功率为54%,完成治疗的人群为71%.
- 死亡率为11%,13%的患者失败.
- 治疗失败与多药性耐药性,治疗后的阳性唾液,腔腔疾病和不良遵守有关.
结论:
- DOTS计划的有效性 (54%) 远远低于世卫组织的目标 (85%).
- 在抗生素耐药性较高的地区,一线治疗可能不足.
- 监狱环境需要定制策略来有效打击结核病.
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