EFFICACY OF TWICE WEEKLY TREATMENT FOR TUBERCULOSIS GIVEN UNDER DIRECT OBSERVATION IN AFRICA

The efficacy of a 6 months course of twice weekly therapy with 4 drugs for tuberculosis, preceded by a 2-3 weeks intensive daily phase, is u nknown. Implementation of this regime as community-based directly obse rved therapy in AG ica is highly effective (85% completion rate); it i s important to estimate the efficacy of the regime before advocating i ts widespread use and before conducting prospective trials. We retrosp ectively evaluated 109 consecutive adults with culture-positive pulmon ary tuberculosis who had documented completion of treatment; 84 (77%) were traced and in 15 (14%) a history was obtained from a close relati ve; 10 (9%) had left the area. Nineteen patients were producing sputum and 4 of these were culture-positive for Mycobacterium tuberculosis, giving an estimated cure rate of 95% (95% confidence interval, 89-98%) . Follow-up specimens revealed no acquired drug resistance and restric tion fragment length polymorphism analysis of patient-paired specimens showed them to be nearly identical, indicating that treatment had fai led or there had been early relapse. This preliminary study suggested that generally twice weekly 4-drug treatment for tuberculosis, given u nder direct observation, is curative in an acceptable proportion of pa tients. Prospective trials are indicated.