Initial Drug Regimens for the Treatment of Tuberculosis
Evaluation of Physician Prescribing Practices in New Jersey, 1994 to 1995
Drug resistance of Mycobacterium tuberculosis has been documented for decades. The emergence of increased multidrug-resistant TB (MDRTB), however, has been observed only in recent years. Worldwide spread of MDRTB has raised a great challenge in the control and prevention of the disease. Adequate treatment of persons with TB and MDRTB is the single most important strategy for preventing the occurrence and transmission of MDRTB. In response to the emergence of MDRTB, the Centers for Disease Control and Prevention (CDC) recommended in 1993 that initial drug regimens for the treatment of TB should include four drugs in areas with a high level of drug resistance (ie, ^4% isoniazid resistance). In 1994, the American Thoracic Society (ATS) joined with CDC in support of the four-drug regimen for initial treatment of TB in areas of high resistance. The initial four-drug regimen was also recommended for the treatment of TB patients who had had previous treatment with anti-TB medications, who were from countries with a high prevalence of drug resistance, and who had known exposure to a drug-resistant case. This regimen was intended to prevent the development of MDRTB in areas where primary isoniazid resistance was increasing. Physician prescribing practices, however, have not been evaluated subsequent to these recommendations. It is unknown which patient and physician characteristics are associated with the noncompliance with the CD C/ATS recommendations. canadian health&care mall
In a nationwide survey conducted in 1991, the proportion of MDRTB (defined as resistance to at least isoniazid and rifampin) in New Jersey was 6.6%, and the state was ranked second highest in the United States, after New York State (12.9%). During 1994 and 1995, the proportion of TB patients with isoniazid resistance in New Jersey was 10%, much higher than the CDC/ATS suggested threshold for a four-drug regimen. In New Jersey, 98% of TB cases were reported from counties with an isoniazid-resistant proportion of 4% or more. These data indicate that all persons with TB in New Jersey should be initially treated with four drugs according to the CDC/ATS recommendation. The early phase of treatment is crucial for preventing emerging drug resistance and determining the ultimate outcome of the treatment. An initial four-drug regimen is highly effective, even for isoniazid-resistant TB, and is associated with faster sputum conversion among drug-susceptible TB patients.
The purpose of this study was to evaluate physician prescribing practices in New Jersey for the initial treatment of TB and compare them with the practices recommended by CDC/ATS.