Standard short-course chemotherapy drug-resistant tuberculosis: Treatment outcomes in 6 countries

Marcos A. Espinal, Sang Jae Kim, Pedro G. Suarez, Kai Man Kam, Alexander G. Khomenko, Giovanni B. Migliori, Janette Baéz, Arata Kochi, Christopher Dye, Mario C. Raviglione

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Context: No large-scale study has investigated the impact of multidrug- resistant tuberculosis (TB) on the outcome of standard short-course chemotherapy under routine countrywide TB control program conditions in the World Health Organization's (WHO) directly observed treatment short-course strategy for TB control. Objective: To assess the results of treatment with first-line drugs for patients enrolled in the WHO and the International Union Against Tuberculosis and Lung Disease's global project on drug-resistance surveillance. Design and Setting: Retrospective cohort study of patients with TB in the Dominican Republic, Hong Kong Special Administrative Region (People's Republic of China), Italy, Ivanovo Oblast (Russian Federation), the Republic of Korea, and Peru. Patients: New and retreatment TB cases who received short-course chemotherapy with isoniazid, rifampicin, pyrazinamide, and either ethambutol or streptomycin between 1994 and 1996. Main Outcome Measure: Treatment response according to WHO treatment outcome categories (cured; died; completed, defaulted, or failed treatment; or transferred). Results: Of the 6402 culture-positive TB cases evaluated, 5526 (86%) were new cases and 876 (14%) were retreatment cases. A total of 1148 (20.8%) new cases and 390 (44.5%) retreatment cases were drug resistant, including 184 and 169 cases of multidrug-resistant TB, respectively. Of the new cases 4585 (83%) were treated successfully, 138 (2%) died, and 151 (3%) experienced short- course chemotherapy failure. Overall, treatment failure (relative risk [RR], 15.4; 95% confidence interval [CI], 10.6-22.4; P

Original languageEnglish
Pages (from-to)2537-2545
Number of pages9
JournalJournal of the American Medical Association
Issue number19
Publication statusPublished - May 17 2000

ASJC Scopus subject areas

  • Medicine(all)


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