Should we take a history of prior treatment, and check sputum status at 2-3 months when treating patients for tuberculosis?

David Wilkinson*, S. Bechan, C. Connolly, E. Standing, G. M. Short

*Corresponding author for this work

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

SETTING: Pinetown, South Africa (1975-1983). OBJECTIVE: To determine the value of previous treatment history and sputum smear examination at 2-3 months in predicting treatment failure and relapse in tuberculosis patients treated with four drugs given twice weekly for six months under direct observation. DESIGN: Four cohort studies among 562 ambulant adults with culture positive pulmonary tuberculosis, designed to test the effectiveness of isoniazid 600-900 mg, rifampicin 600 mg, pyrazinamide 2-3 g, and streptomycin 1-2 g, given twice weekly. The same drug regimen was given to all patients irrespective of previous treatment history. Therapy was not changed if smears remained positive at 2-3 months. RESULTS: Positive predictive values of a history of previous treatment for a positive smear at 2-3 months (18.3%), treatment failure (5.2%), and relapse (9.4%) were poor. Although patients with positive smears at 2-3 months were more likely to fail therapy than patients with negative smears (relative risk = 4.5, 95% Confidence Interval [CI]: 1.6-12.8), positive predictive value for treatment failure was only 12.5%. Although relapse was more frequent in patients with positive smears than those with negative smears (9.7% vs 6.2%; P = 0.4), most patients who relapsed had been smear negative at 2-3 months (18/21). CONCLUSION: A four-drug rifampicin-containing regimen can safely be given twice weekly under direct observation to both new and retreatment cases, and the 2-3 month smear examination can safely be omitted.

Original languageEnglish
Pages (from-to)52-55
Number of pages4
JournalInternational Journal of Tuberculosis and Lung Disease
Volume2
Issue number1
Publication statusPublished - 1998
Externally publishedYes

Keywords

  • Sputum smear examination
  • Treatment history
  • Tuberculosis

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