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Clinical Investigations: TUBERCULOSIS |

Treatment of Isoniazid-Resistant Tuberculosis in Southeastern Texas*

Patricio Escalante, MD; Edward A. Graviss, PhD, MPH; David E. Griffith, MD, FCCP; James M. Musser, MD, PhD; Robert J. Awe, MD, FCCP
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*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@aol.com



Chest. 2001;119(6):1730-1736. doi:10.1378/chest.119.6.1730
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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.

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