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背景:洛山矶县卫生服务科。目的:确定在有治疗中断情况下,病人自服异烟肼利福平固定剂量复合制剂(下简称HR复合剂)对防止产生获得性耐药的意义。设计:75％的病人自服HR复合剂,25％病人接受散装异烟肼(H)及利福平(R)的直接督导治疗(DOT)。四分之三病人完成了治疗。我们通过调查确定以下方面的内容:1)经过3个月以上治疗仍对HR敏感的病人数作为药物敏感型治疗失败与复发的测量指标,2)以初始药物敏感者以后产生耐药的病人数作为获得性耐药的测量指标,3)产生获得性耐药者所采用的治疗方案。 结果:在5337例已知或假设为HIV(-)的药物敏感结核病人中,共有152例(2.84％)治疗失败或复发。在152例中有25例(0.47％)产生获得性耐药。采用HR复合剂或基本上采用HR复合剂的近4000例结核病人中,仅有8例(0.2％)产生耐药性,即使包括治疗史不详的病人,也仅有12例产生耐药(0-3％)。结论:mV(-)结核病人自服HR复合剂治疗很少发生获得性耐药。
Background: Los Angeles County Health Services Section. PURPOSE: To determine the significance of self-care isoniazid rifampin fixed-dose combination (HR complex) to prevent the development of acquired resistance in the presence of treatment disruption. Design: Seventy-five percent of patients self-serve HR complex and 25% of patients receive direct supervising treatment (DOT) of bulk isoniazid (H) and rifampin (R). Three-quarters of patients completed the treatment. We investigated the following aspects: 1) the number of patients who remained HR-sensitive for more than 3 months as a measure of failure and recurrence of drug-sensitive treatment; 2) the number of future drug-resistant patients who developed resistance As a measure of acquired resistance, 3) the treatment regimen used by those who acquired acquired resistance. RESULTS: Of the 5337 drug-sensitive TB patients known or presumed to be HIV (-), 152 (2.84%) had failed or relapsed. In 152 cases, 25 (0.47%) developed acquired resistance. Only 8 (0.2%) of the almost 4000 tuberculosis patients with HR complex or essentially HR complex developed resistance, even in patients with unknown history of therapy (12 -3%). CONCLUSIONS: Acquired resistance is rare in mV (-) TB patients treated with HR complex.