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  • Title: Therapeutic review: tuberculosis.
    Author: Houston S, Pozniak A, Ray CS.
    Journal: Cent Afr J Med; 1991 Aug; 37(8):250-9. PubMed ID: 1807799.
    Abstract:
    Tuberculosis (TB) is increasing in Zimbabwe and other countries in Africa and world-wide. TB treatment and control face new difficulties including the impact of the HIV epidemic and drug resistance. There is now abundant evidence that six-month regimens are highly effective and, by improving compliance, can improve results and the cost-effectiveness of therapy. Intermittent therapy reduces drug costs and allows for the possibility of complete supervision. The optimal management of the HIV-infected TB patient has not yet been established but an increased rate of drug reactions suggests that standard treatment should be reassessed. Each year, tuberculosis (TB) affects 10 million people and kills 3 million people all in the 15-53 year age group--the group which supports society economically and socially. It comprises the largest percentage of avoidable adult deaths (29%) in developing countries. The TB incidence is rising worldwide which, evidence indicates, is probably due to the HIV epidemic. Between mid-1988 to mid-1989, prevalence of HIV seropositivity among TB patients in Harare rose from 33% to 47%. Among the 20-40 year old male TB patients, 63.7% were HIV positive. Some evidence in Zimbabwe and elsewhere shows that TB responds well to standard treatment in most HIV positive patients. The most important public health measure against TB is to treat it with effective antibiotic regimens (95% relapse-free cure rates), but many TB treatments fail due to poor patient compliance. In fact, operational surveys of TB programs show that poor compliance is very common. Various forms of treatment include short course chemotherapy (6 months) and intermittent therapy (e.g., 2 doses each week). Various TB antibiotics are isoniazid, rifampicin, INH, pyrazinamide, thiacetazone, streptomycin, and ethambutol. Some new possible antibiotics are emerging such as ansamycin and ciprofloxacin used to treat atypical mycobacteria. The Harare City Health Department in Zimbabwe has evidenced a 5-fold increase in the risk of a drug reaction in HIV infected TB patients. Thiacetazone and streptomycin were involved in 85% of these reactions. Antituberculosis treatment is costly in sub- Saharan Africa. Drug costs make up only 30% of the medical costs of outpatient treatment and only 5% for 1-2 months hospitalization. Nondrug costs include patient travel costs, time lost from work, and compromised job security and income. Thus developing countries should adopt the already known to be effective 6-month regimen for TB treatment.
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