Replacement of streptomycin by ethambutol in the intensive phase of tuberculosis treatment: no effect on compliance

SETTING: Seven tuberculosis clinics in the National Tuberculosis Programme of Madagascar. OBJECTIVE: To compare the treatment efficacy and tolerance of regimens incl uding either streptomycin or ethambutol for patient compliance during initi al treatment of smear-positive tuberculosis. DESIGN: The 1023 patients included in the study were randomly divided into two treatment groups-one to receive streptomycin (S), isoniazid (H), rifamp icin (R) and pyrazinamide (Z) (SHRZ), and the other to receive EHRZ, where streptomycin was replaced by ethambutol (E). During the 2-month intensive p hase, drug delivery was completely supervised. The same 6-month continuatio n regimen was then given in both groups. Follow-up consisted of a clinical and bacteriological examination at the end of the second, fifth and eighth months. RESULTS: There was no significant difference between the two regimens as re gards compliance with treatment, the number of patients lost or who died, o r for bacteriological response during the intensive phase. EHRZ was better tolerated. During the continuation phase, the results of the two groups rem ained comparable, but treatment failures occurred earlier in the patients w ho had received streptomycin. CONCLUSION: Patient compliance was not better with streptomycin. The ethamb utol-containing regimen was as efficient as the other, and better tolerated . There is no argument for preferring streptomycin in the intensive phase o f treatment of smear-positive tuberculosis.