To determine if isoniazid-and/or rifampicin-free antituberculosis treatment regimens are safe and effective and to identify any factors that might require changes in the regimens.
Patients and methodsWe carried out a retrospective study of patients treated with isoniazid-and/or rifampicin-free regimens between 1995 and 2005 at 2 specialized hospitals in Barcelona, Spain. Predictive factors were studied by logistic regression and the odds ratio; 95% confidence intervals were calculated.
ResultsEighty-five patients were included in the study: 35% were immigrants and 34% were infected with human immunodeficiency virus. The reason for omitting isoniazid or rifampicin was toxicity (53%), followed by multidrug resistance (39%). Rifampicin-free regimens were most common (42%). A change in the isoniazid-and/or rifampicin-free regimen was required in 30% of cases, but was not associated with being an immigrant. The rate of toxicity with these regimens was higher (36%), although progress was always satisfactory. Clinical course was satisfactory in 77% of patients and they were discharged.
ConclusionsIsoniazid-and/or rifampicin-free regimens with adequate follow-up showed similar treatment outcomes compared with standardized treatment regimens. Although these regimens were more toxic, patient progress was good.
Determinar si las pautas de tratamiento antituberculoso sin isoniacida y/o rifampicina (PsHR) son efectivas y seguras, y conocer los factores que obligan a cambiarlas.
Pacientes y métodosSe ha realizado un estudio retrospectivo de los pacientes tratados con PsHR entre 1995 y 2005 en 2 centros especializados de Barcelona. Los factores predictores se estudiaron mediante regresión logística, calculándose las odds ratio y sus intervalos de confianza del 95%.
ResultadosSe incluyó en el estudio a 85 pacientes. Un 35% eran inmigrantes y un 34% estaban infectados por el virus de la inmunodeficiencia humana. La causa de no administrar isoniacida y/o rifampicina fue sobre todo la toxicidad (53%), seguida de resistencia a fármacos antituberculosos (39%). Las pautas sin rifampicina fueron las más frecuentes (42%). Fue preciso cambiar la PsHR en el 30% de los casos y esto se asoció a no ser inmigrante. La toxicidad de las pautas fue más elevada (36%), aunque su evolución fue siempre favorable. El 77% de los pacientes tuvo una evolución satisfactoria y fue dado de alta.
ConclusionesLas PsHR, con un buen seguimiento, poseen una efectividad similar a las pautas estándar y, aunque su toxicidad es más elevada, ésta sigue una evolución correcta.
This study was funded in part by a grant from the Catalan Society de Pneumology (SOCAP) in 2006 for the Development of Pulmonology Research.
