First-line tuberculosis therapy and drug-resistant Mycobacterium tuberculosis in prisons

Background We assessed a programme of tuberculosis control in a prison sett ing in Baku, Azerbaijan. The programme used first-line therapy and DOTS (di rectly observed treatment, short course). Methods 467 patients had sputum-positive tuberculosis. Their treatment regi mens followed WHO guidelines, and they had regular clinical examinations an d dietary supplements. Isolates were tested by standard methods for resista nce to isoniazid, rifampicin, ethambutol, and streptomycin in three laborat ories. Treatment success was defined as three consecutive negative sputum s mears at end of treatment. Factors independently associated with treatment failure were estimated by logistic regression. Findings Drug-resistance data on admission were available for 131 patients. 55% of patients had strains of Mycobacterium tuberculosis resistant to two or more antibiotics. Mortality during treatment was 11%, and 13% of patien ts defaulted. Overall, treatment was successful in 54% of patients, and in 71% of those completing treatment. 104 patients completed a full treatment regimen and remained sputum-positive. Resistance to two or more antibiotics , a positive sputum result at the end of initial treatment, cavitary diseas e, and poor compliance were independently associated with treatment failure . Interpretation The effectiveness of a DOTS programme with first-line therap y fell short of the 85% target set by WHO. First-line therapy may not be su fficient in settings with a high degree of resistance to antibiotics.