Initial Drug Regimens for the Treatment of Tuberculosis: Factors Associated With Patients Treated With Fewer Than Four Drugs Initially
Recurrent TB patients were more likely to be treated with four or more drugs initially than new patients. This is consistent with a high proportion of drug resistance in recurrent TB cases. Yet, 22% of the recurrent TB patients were not treated with four or more drugs initially. In this study, excessive alcohol use and injecting drug use were not associated with a high proportion of isoniazid resistance. However, TB patients with these two characteristics were more likely to be initially treated with four or more drugs than those without these characteristics. Among TB patients with HIV infection, 15% were initially treated with fewer than four drugs. Overall, however, patients with HIV infection were more likely to be treated with four or more drugs than those without HIV infection. cialis professional 20 mg
Relationship Between Initial Care Providers and Initial Drug Regimens
TB patients were classified into four groups based on their initial care providers: 11% were initially treated at the hospital or the chest clinic of the New Jersey Medical School, University of Medicine and Dentistiy of New Jersey (UMDNJ-MS), 72% at other hospitals, 8% at other chest clinics, and 10% at private physicians’ offices. The majority of the TB patients were initially treated at hospitals. The proportion of isoniazid resistance in the four groups was 4.5%, 9.6%, 21.5%, and 13.6%, respectively (Table 2). The TB patients who were initially treated at UMDNJ-MS were chosen as the reference group because the federally funded New Jersey Medical School National Tuberculosis Center is located at the medical school. The assumption was that the TB patients treated at the medical school might receive more appropriate initial therapy than those treated at other institutions, and the subsequent analysis supported this assumption. Among patients who were initially treated at UMDNJ-MS, only 8.2% were treated with fewer than four drugs, compared with 36.8% at other hospitals, 41.9% at other chest clinics, and 51.7% at private physicians’ offices. Patients who were initially treated by private physicians had the highest prevalence of MDRTB (6.8%). After adjustment for demographic characteristics and other potential risk factors, private physicians and physicians at other chest clinics were about five times as likely to prescribe regimens with fewer than four drugs as physicians at UMDNJ-MS (Table 2). Physicians at other hospitals were about four times as likely to prescribe fewer than four drugs as those at UMDNJ-MS.