TY - JOUR
T1 - The effect of directly observed therapy on the rates of drug resistance and relapse in tuberculosis
AU - Weis, Stephen E.
AU - Slocum, Philip C.
AU - Blais, Francis X.
AU - King, Barbara
AU - Nunn, Mary
AU - Matney, G. Burgis
AU - Gomez, Enriqueta
AU - Foresman, Brian H.
PY - 1994/4/28
Y1 - 1994/4/28
N2 - Tuberculosis has reemerged as an important public health problem, and the frequency of drug resistance is increasing. A major reason for the development of resistant infections and relapse is poor compliance with medical regimens. In Tarrant County, Texas, we initiated a program of universal directly observed treatment for tuberculosis. We report the effect of the program on the rates of primary and acquired drug resistance and relapse among patients with tuberculosis. We collected information on all patients with positive cultures for Mycobacterium tuberculosis in Tarrant County from January 1, 1980, through December 31, 1992. Through October 1986, patients received a traditional, unsupervised drug regimen. Beginning in November 1986, nearly all patients received therapy under direct observation by health care personnel. A total of 407 episodes in which patients received traditional treatment for tuberculosis (January 1980 through October 1986) were compared with 581 episodes in which therapy was directly observed (November 1986 through December 1992). Despite higher rates of intravenous drug use and homelessness and an increasing rate of tuberculosis during this 13-year period, the frequency of primary drug resistance decreased from 13.0 percent to 6.7 percent (P<0.001) after the institution of direct observation of therapy, and the frequency of acquired resistance declined from 14.0 percent to 2.1 percent (P<0.001). The relapse rate decreased from 20.9 percent to 5.5 percent (P<0.001), and the number of relapses with multidrug-resistant organisms decreased from 25 to 5 (P<0.001). The administration of therapy for M. tuberculosis infection under direct observation leads to significant reductions in the frequency of primary drug resistance, acquired drug resistance, and relapse.
AB - Tuberculosis has reemerged as an important public health problem, and the frequency of drug resistance is increasing. A major reason for the development of resistant infections and relapse is poor compliance with medical regimens. In Tarrant County, Texas, we initiated a program of universal directly observed treatment for tuberculosis. We report the effect of the program on the rates of primary and acquired drug resistance and relapse among patients with tuberculosis. We collected information on all patients with positive cultures for Mycobacterium tuberculosis in Tarrant County from January 1, 1980, through December 31, 1992. Through October 1986, patients received a traditional, unsupervised drug regimen. Beginning in November 1986, nearly all patients received therapy under direct observation by health care personnel. A total of 407 episodes in which patients received traditional treatment for tuberculosis (January 1980 through October 1986) were compared with 581 episodes in which therapy was directly observed (November 1986 through December 1992). Despite higher rates of intravenous drug use and homelessness and an increasing rate of tuberculosis during this 13-year period, the frequency of primary drug resistance decreased from 13.0 percent to 6.7 percent (P<0.001) after the institution of direct observation of therapy, and the frequency of acquired resistance declined from 14.0 percent to 2.1 percent (P<0.001). The relapse rate decreased from 20.9 percent to 5.5 percent (P<0.001), and the number of relapses with multidrug-resistant organisms decreased from 25 to 5 (P<0.001). The administration of therapy for M. tuberculosis infection under direct observation leads to significant reductions in the frequency of primary drug resistance, acquired drug resistance, and relapse.
UR - http://www.scopus.com/inward/record.url?scp=0028274105&partnerID=8YFLogxK
U2 - 10.1056/NEJM199404283301702
DO - 10.1056/NEJM199404283301702
M3 - Article
C2 - 8139628
AN - SCOPUS:0028274105
SN - 0028-4793
VL - 330
SP - 1179
EP - 1184
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 17
ER -