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Park, Kim, Shin, and Jun: A Retrospective Study for Relapse Rate According to the Discontinuance of Para-aminosalicylic acid(PAS) after Bacteriological Conversion during the Course of Chemotherapy for Multidrug- Resistant Tuberculosis(MDR-TB)
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2006; 60(2): 180-186.

Published online: 28 February 2006

DOI: https://doi.org/10.4046/trd.2006.60.2.180

A Retrospective Study for Relapse Rate According to the Discontinuance of Para-aminosalicylic acid(PAS) after Bacteriological Conversion during the Course of Chemotherapy for Multidrug- Resistant Tuberculosis(MDR-TB)

Seung-Kyu Park, M.D., Ph.D.1, Byoung-Ju Kim, M.D.1, Dong-Ohk Shin, R.N., Byung-Yool Jun, M.D., Ph.D.

Clinical Research Center, National Masan TB Hospital, Korea.

1International Tuberculosis Research Center, Masan, Korea.

Address for correspondence: Seung-Kyu Park, M.D., Ph.D. Director of International Tuberculosis Research Center, Kapo-dong, Masan, Gyeongnam, 631-710, Korea. Phone: 055-249-3728, Fax: 055-241-0992, pulmo116@empal.com

Received 20 December 2005       Accepted 2 February 2006

Copyright © 2006 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

Background

Para-aminosalicylic acid(PAS) is a 2nd-line drug that can cause severe adverse reactions leading to poor patient compliance. This study evaluated the relapse rate according to the discontinuance of PAS at a certain point after bacteriological conversion during the course of chemotherapy for multidrug-resistant tuberculosis(MDR-TB).

Methods

42 out of 452 MDR-TB patients were enrolled in this study. All subjects were receiving chemotherapy including PAS at National Masan TB Hospital between Jan. 1, 2000 and Dec. 31, 2001. The relapse rate was evaluated after the discontinuance of PAS from their initial regimen as a result of the severe adverse reactions at a certain point after the bacteriological conversion during the course of chemotherapy for MDR-TB.

Results

The male to female ratio was 2.5:1, and the mean age was 47.2 years old. The average number of past histories, used drugs and resistant drugs was 1.2, 3.9 and 4.3 . The mean number of sensitive drugs included in the inirial regimen was 3.9 . The mean time for bacteriological conversion and discontinuance of the PAS was 2.3 months after initiating treatment and 6 months after bacteriological conversion, respectively. There was no relapse after discontinuing PAS during a mean follow up period of 31.6 months.

Conclusion

PAS may be discontinued in the cases of serious gastrointestinal problems approximately 6 months after bacteriological conversion without concern about relapse.

Keywords: Para-aminosalicylic acid(PAS), Multidrug-resistant tuberculosis, Compliance

Figures and Tables

Table 1
Clinical characteristics of 42 subjects who have stopped taking PAS after conversion during the course of MDR-TB chemotherapy
trd-60-180-i001

*months after bacteriological conversion

Table 2
Anti-tuberculosis drug resistance in 42 MDR-TB subjects
trd-60-180-i002

EMB: ethambutol; SM: streptomycin; PAS: para-amin osalicylic acid OFX: ofloxacin; PZA: pyrazinamide; KM: kanamycin; CS: cycloserine; ETH: ethionamide

References

1. Kritski AL, Rodrigues de Jesus LS, Andrade MK, Werneck-Barroso E, Vieira MA, Haffner A, et al. Retreatment tuberculosis cases: factors associated with drug resistance and adverse outcomes. Chest. 1997. 111:1162–1167.
2. Bechan S, Connolly C, Short GM, Standing E, Wilkinson D. Directly observed therapy for tuberculosis given twice weekly in the workplace in urban South Africa. Trans R Soc Trop Med Hyg. 1997. 91:704–707.
3. Goble M, Iseman MD, Madsen LA, Waite D, Ackerson L, Horsburgh CR Jr. Treatment of 171 patients with pulmonary tuberculosis resistant to isoniazid and rifampin. N Engl J Med. 1993. 328:527–532.
4. Weis SE, Slocum PC, Blais FX, King B, Nunn M, Matney GB, et al. The effect of directly observed therapy on the rates of drug resistance and relapse in tuberculosis. N Engl J Med. 1994. 330:1179–1184.
5. Pearce SJ, Horne NW. Follow-up of patients with pulmonary tuberculosis adequately treated by chemotherapy: is this really necessary? Lancet. 1974. 2:641–643.
6. Singapore Tuberculosis Service/Birtish Medical Research Council. Five-year follow-up of a clinical trial of three 6-month regimens of chemotherapy given intermittently in the continuation phase in the treatment of pulmonary tuberculosis. Am Rev Respir Dis. 1988. 137:1147–1150.
7. Kopanoff DE, Snider DE Jr, Johnson M. Recurrent tuberculosis: why do patients develop disease again? Am J Public Health. 1988. 78:30–33.
8. Burman WJ, Cohn DL, Rietmeijer CA, Judson FN, Sbarbaro JA, Reves RR. Noncompliance with directly observed therapy for tuberculosis: epidemiology and effect on the outcome of treatment. Chest. 1997. 111:1168–1173.
9. Jarvis B, Lamb HM. Rifapentine. Drugs. 1998. 56:607–616.
10. Addington WW. Patient compliance: the most serious remaining problem in the control of tuberculosis in the United States. Chest. 1979. 76:741–743.
11. Davidson PT, Le HQ. Drug treatment of tuberculosis:1992. Drugs. 1992. 43:651–673.
12. Kilpatrick GS. Compliance in relation to tuberculosis. Tubercle. 1987. 68:31–32.
13. Cueno WD, Snider DE Jr. Enhancing patient compliance with tuberculosis therapy. Clin Chest Med. 1989. 10:375–380.
14. Snider DE Jr, Roper WL. The new tuberculosis. N Engl J Med. 1992. 326:703–705.
15. Bloch AB, Cauthen GM, Simone PM, Kelly GD, Dansbury KG, Castro KG. Completion of tuberculosis therapy for patients reported in the United States in 1993. Int J Tuberc Lung Dis. 1999. 3:273–280.
16. American Thoracic Society. CDC. Infectious Diseases Society of America. Treatment of tuberculosis. MMWR Recomm Rep. 2003. 52:1–77.
17. Centers for Disease Control. Patients with recurrent tuberculosis. MMWR Morb Mortal Wkly Rep. 1982. 30:645–647.
18. la Raja M, Screm C, Talmassons G, Pasquadibisceglie A, Pitzalis G, Pitzus E. Antituberculosis drug-resistance surveillance as a tool for tuberculosis control programmes. Monaldi Arch Chest Dis. 1997. 52:450–454.
19. Strull GE, Dym H. Tuberculosis: diagnosis and treatment of resurgent disease. J Oral Maxillofac Surg. 1995. 53:1334–1340.
20. Canetti G, Froman S, Grosset J, Hauduroy P, Langerova M, Mahler HT, et al. Mycobacteria: laboratory methods for testing drug sensitivity and resistance. Bull World Health Organ. 1963. 29:565–578.
21. Park SK, Lee WC, Lee DH, Mitnick CD, Han L, Seung KJ. Self-administered, standardized regimens for multidrug-resistant tuberculosis in South Korea. Int J Tuberc Lung Dis. 2004. 8:361–368.
22. Kim HK, Hong YP, Kim SJ, Lew WJ, Lee EG. Ambulatory treatment of multidrug-resistant tuberculosis patients at a chest clinic. Int J Tuberc Lung Dis. 2001. 5:1129–1136.
23. Volmink J, Matchaba P, Garner P. Directly observed therapy and treatment adherence. Lancet. 2000. 355:1345–1350.
24. Mangura B, Napoltano E, Pascannante M, Sarrel M, McDonald R, Galanowsky K, et al. Directly observed therapy(DOT) is not the entire answer: an operational cohort analysis. Int J Tuberc Lung Dis. 2002. 6:654–661.
25. Bernheim F. Effect of salicylates on oxygen uptake of tubercle bacillus. Science. 1940. 92:204.
26. Lehman J. Para-aminosalicylic acid in the treatment of tuberculosis. Lancet. 1946. 250:15–16.
27. Lorian V. Antibiotics in laboratory medicine. 1986. 2nd ed. Baltimore: Williams & Wilkins.
28. Rengarajan J, Sassetti CM, Naroditskaya V, Sloutsky A, Bloom BR, Rubin EJ. The folate pathway is a target for resistance to the drug para-aminosalicylic acid (PAS) in mycobacteria. Mol Microbiol. 2004. 53:275–282.
29. Kucers A, Bennett N. The use of antibiotics. 1979. 3rd ed. London: Heinemann.
30. Pfuetze K, de la Huerga J, Frakis A. Out-patient acceptance of PAS: transactions of the 20th research conference in pulmonary diseases. 1961. Washington, DC: Veterans Administration Department of Medicine and Surgery.
31. Ormerod LP. Multidrug-resistant tuberculosis(MDR-T B): epidemiology, prevention and treatment. Br Med Bull. 2005. 73:17–24.
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