Does DOTS work in populations with drug-resistant tuberculosis?

Kathryn DeRiemer, Lourdes García-García, Miriam Bobadilla-del-Valle, Manuel Palacios-Martínez, Areli Martínez-Gamboa, Peter M. Small, José Sifuentes-Osornio, Alfredo Ponce-De-León

Research output: Contribution to journalArticle

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Abstract

Background: Directly observed therapy (DOTS) is the main strategy for prevention and control of tuberculosis worldwide. However, its effect on tuberculosis transmission in populations with moderate rates of drug-resistant disease is not known. Methods: This population-based prospective study in southern Mexico between March, 1995, and February, 2000, was based on passive case finding and detection of acid-fast bacilli in sputum samples to diagnose pulmonary tuberculosis. We also used cultures, drug-susceptibility testing, bacterial genotyping, and monitoring of treatment outcomes. Findings: We enrolled 436 patients; the HIV seroprevalence rate was 2%. We used three indicators to monitor continuing tuberculosis transmission: the incidence rate of pulmonary tuberculosis, which decreased by 54·4% between 1995 and 2000, from 42·1 to 19·2 per 105 population (p=0·00048); the percentage of clustered pulmonary tuberculosis cases, which decreased by 62·6% from 22% to 8% (p=0·02); and the rate of primary drug resistance, which decreased by 84·0% from 9·4 to 1·5 per 105 population (p=0·004). Rates of multidrug-resistant (MDR) tuberculosis also decreased (p<0·0001). The case-fatality ratio was 12% for MDR tuberculosis (five of 41), 7% for strains resistant to at least one drug after exclusion of MDR (four of 55), and 3% for pansusceptible strains (nine of 272). There were 13 treatment failures (11%) in 1995 and one (2%) in 2000 (p=0·012). Interpretation: Even in settings with moderate rates of MDR tuberculosis, DOTS can rapidly reduce the transmission and incidence of both drug-susceptible and drug-resistant tuberculosis. However, further interventions, such as drug-susceptibility testing and standardised or individualised treatment regimens, are needed to reduce mortality rates for MDR tuberculosis.

Original languageEnglish (US)
Pages (from-to)1239-1245
Number of pages7
JournalLancet
Volume365
Issue number9466
DOIs
StatePublished - Apr 2 2005
Externally publishedYes

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Multidrug-Resistant Tuberculosis
Pulmonary Tuberculosis
Tuberculosis
Pharmaceutical Preparations
Population
Directly Observed Therapy
HIV Seroprevalence
Incidence
Mexico
Sputum
Treatment Failure
Drug Resistance
Bacillus
Prospective Studies
Acids
Mortality

ASJC Scopus subject areas

  • Medicine(all)

Cite this

DeRiemer, K., García-García, L., Bobadilla-del-Valle, M., Palacios-Martínez, M., Martínez-Gamboa, A., Small, P. M., ... Ponce-De-León, A. (2005). Does DOTS work in populations with drug-resistant tuberculosis? Lancet, 365(9466), 1239-1245. https://doi.org/10.1016/S0140-6736(05)74812-1

Does DOTS work in populations with drug-resistant tuberculosis? / DeRiemer, Kathryn; García-García, Lourdes; Bobadilla-del-Valle, Miriam; Palacios-Martínez, Manuel; Martínez-Gamboa, Areli; Small, Peter M.; Sifuentes-Osornio, José; Ponce-De-León, Alfredo.

In: Lancet, Vol. 365, No. 9466, 02.04.2005, p. 1239-1245.

Research output: Contribution to journalArticle

DeRiemer, K, García-García, L, Bobadilla-del-Valle, M, Palacios-Martínez, M, Martínez-Gamboa, A, Small, PM, Sifuentes-Osornio, J & Ponce-De-León, A 2005, 'Does DOTS work in populations with drug-resistant tuberculosis?', Lancet, vol. 365, no. 9466, pp. 1239-1245. https://doi.org/10.1016/S0140-6736(05)74812-1
DeRiemer K, García-García L, Bobadilla-del-Valle M, Palacios-Martínez M, Martínez-Gamboa A, Small PM et al. Does DOTS work in populations with drug-resistant tuberculosis? Lancet. 2005 Apr 2;365(9466):1239-1245. https://doi.org/10.1016/S0140-6736(05)74812-1
DeRiemer, Kathryn ; García-García, Lourdes ; Bobadilla-del-Valle, Miriam ; Palacios-Martínez, Manuel ; Martínez-Gamboa, Areli ; Small, Peter M. ; Sifuentes-Osornio, José ; Ponce-De-León, Alfredo. / Does DOTS work in populations with drug-resistant tuberculosis?. In: Lancet. 2005 ; Vol. 365, No. 9466. pp. 1239-1245.
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abstract = "Background: Directly observed therapy (DOTS) is the main strategy for prevention and control of tuberculosis worldwide. However, its effect on tuberculosis transmission in populations with moderate rates of drug-resistant disease is not known. Methods: This population-based prospective study in southern Mexico between March, 1995, and February, 2000, was based on passive case finding and detection of acid-fast bacilli in sputum samples to diagnose pulmonary tuberculosis. We also used cultures, drug-susceptibility testing, bacterial genotyping, and monitoring of treatment outcomes. Findings: We enrolled 436 patients; the HIV seroprevalence rate was 2{\%}. We used three indicators to monitor continuing tuberculosis transmission: the incidence rate of pulmonary tuberculosis, which decreased by 54·4{\%} between 1995 and 2000, from 42·1 to 19·2 per 105 population (p=0·00048); the percentage of clustered pulmonary tuberculosis cases, which decreased by 62·6{\%} from 22{\%} to 8{\%} (p=0·02); and the rate of primary drug resistance, which decreased by 84·0{\%} from 9·4 to 1·5 per 105 population (p=0·004). Rates of multidrug-resistant (MDR) tuberculosis also decreased (p<0·0001). The case-fatality ratio was 12{\%} for MDR tuberculosis (five of 41), 7{\%} for strains resistant to at least one drug after exclusion of MDR (four of 55), and 3{\%} for pansusceptible strains (nine of 272). There were 13 treatment failures (11{\%}) in 1995 and one (2{\%}) in 2000 (p=0·012). Interpretation: Even in settings with moderate rates of MDR tuberculosis, DOTS can rapidly reduce the transmission and incidence of both drug-susceptible and drug-resistant tuberculosis. However, further interventions, such as drug-susceptibility testing and standardised or individualised treatment regimens, are needed to reduce mortality rates for MDR tuberculosis.",
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AU - Martínez-Gamboa, Areli

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