HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via ISI Web of Science (3) Citing Articles via Google Scholar Google Scholar Articles by Escalante, P. Articles by Awe, R. J. Search for Related Content PubMed PubMed Citation Articles by Escalante, P. Articles by Awe, R. J.

Treatment of Isoniazid-Resistant Tuberculosis in Southeastern Texas^*

^* From the Sections of Pulmonary and Critical Care (Drs. Escalante and Awe) and Infectious Diseases (Dr. Graviss), Institute for the Study of Human Bacterial Pathogenesis, Baylor College of Medicine, Houston, TX; the Center for Pulmonary and Infectious Disease Control (Dr. Griffith), University of Texas Health Center at Tyler, Tyler, TX; and the Laboratory of Human Bacterial Pathogenesis (Dr. Musser), Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT.

Correspondence to: Patricio Escalante, MD, Assistant Professor, Division of Pulmonary and Critical Care, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles County Medical Center, 1200 N. State St, GNH 11900, Los Angeles, CA 90033; e-mail: Patricioe{at}aol.com

Background: Isoniazid-resistant tuberculosis (INHr-TB) can be treated successfully with several treatment regimens. However, the optimal regimen and duration are unclear.

Study objective: To analyze the efficacy of treatment regimens used for INHr-TB in the southeastern Texas region.

Design: Retrospective cohort study.

Setting: Health-care facilities reporting tuberculosis (TB) patients in the Houston and Tyler areas.

Subjects: All patients reported to have INHr-TB from 1991 to 1998. Exclusion criteria included poor compliance, additional first-line drug-resistance (except aminoglycosides), and death before completion of 1 month of treatment.

Measurements and results: Main treatment outcomes were treatment failure, relapse, and TB-related death. Fifty-three of 83 patients were included in the study; aminoglycoside resistance coexisted in 37.5% of isolates. Seven types of treatment regimens were identified. Eighteen patients (34%) received rifampin, pyrazinamide, and ethambutol thrice weekly for 9 months. Four patients (7.5%) had a total effective treatment duration of < 9 months. Thirty patients (56.6%) and 16 patients (30.2%) received thrice-daily and daily treatment regimens, respectively. Forty-nine patients achieved sputum conversion. Treatment failure and death occurred in one patient (1.9%). Three patients (5.7%) experienced relapses. There was a significant difference in total effective treatment time between patients with and without relapses (8.3 ± 1.1 months vs 11.1 ± 2.1 months; p < 0.02). Twice-weekly treatment regimens were associated with relapse (p = 0.05).

Conclusions: Several treatment regimens were prescribed for INHr-TB in southeastern Texas. INHr-TB treatment durations were > 7 months, and treatment regimen efficacy was adequate. Twice-weekly treatment was associated with relapse, whereas thrice-weekly and daily treatments performed similarly. A prospective study with different treatment durations is needed to determine the optimal treatment regimen for patients with INHr-TB.

Key Words: drug resistance • isoniazid • isoniazid resistance • relapse • treatment • tuberculosis