This Article Full Text Full Text (PDF) Online Supplement All Versions of this Article: 200407-905OCv1 170/10/1124    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Chang, K. C. Articles by Tam, C. M. Search for Related Content PubMed PubMed Citation Articles by Chang, K. C. Articles by Tam, C. M.

A Nested Case–Control Study on Treatment-related Risk Factors for Early Relapse of Tuberculosis

Tuberculosis and Chest Service, Department of Health; Tuberculosis and Chest Unit, Grantham Hospital; and Department of Community and Family Medicine, School of Public Health, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China

Correspondence and requests for reprints should be addressed to Dr. Kwok Chiu Chang, Yaumatei Chest Clinic, 2/F, Yaumatei Jockey Club Polyclinic, 145, Battery Street, Kowloon, Hong Kong, China. E-mail: ymtcc{at}dh.gov.hk

This nested case–control study aimed at evaluating treatment-related risk factors of relapse of tuberculosis under a service program of directly observed treatment. Out of 12,183 patients with pulmonary tuberculosis who completed treatment within 1 year, 113 relapsed within 30 months after commencement of therapy. The overall 30-month relapse rate was 0.9% (95% confidence interval [CI] 0.8–1.1%). On matching 113 cases with 226 control subjects in a conditional logistic model, thrice-weekly treatment increased the risk of relapse in comparison with daily treatment (odds ratio 3.92, 95% CI 1.78–8.63), whereas prolonging both intensive phase and overall treatment by 50% or more protected against relapse (odds ratio 0.24, 95% CI 0.08–0.70). When pretreatment culture was positive and cavitation was absent, the 30-month relapse rate for standard thrice-weekly regimen was 1.1% (95% CI 0.6–2.0%). The corresponding rates in the presence of cavitation were 7.8% (95% CI 4.0–14.6%) for standard thrice-weekly regimen; 3.3% (95% CI 1.9–5.5%) for standard daily regimen; 0.5% (95% CI 0.1–2.6%) for extended thrice-weekly regimen; and 0.4% (95% CI 0.1–0.9%) for extended daily regimen. Further studies are required to reduce the risk of relapse under program settings.

Key Words: logistic models • recurrence • risk factors • therapeutics • tuberculosis

This article has been cited by other articles:

				E. S. Guy and A. Mallampalli Review: Managing TB in the 21st century: existing and novel drug therapies Therapeutic Advances in Respiratory Disease, December 1, 2008; 2(6): 401 - 408. [Abstract] [PDF]

				I. M. Rosenthal, M. Zhang, D. Almeida, J. H. Grosset, and E. L. Nuermberger Isoniazid or Moxifloxacin in Rifapentine-based Regimens for Experimental Tuberculosis? Am. J. Respir. Crit. Care Med., November 1, 2008; 178(9): 989 - 993. [Abstract] [Full Text] [PDF]

				J. F. Djoba Siawaya, N. B. Bapela, K. Ronacher, N. Beyers, P. van Helden, and G. Walzl Differential Expression of Interleukin-4 (IL-4) and IL-4{delta}2 mRNA, but Not Transforming Growth Factor Beta (TGF-{beta}), TGF-{beta}RII, Foxp3, Gamma Interferon, T-bet, or GATA-3 mRNA, in Patients with Fast and Slow Responses to Antituberculosis Treatment Clin. Vaccine Immunol., August 1, 2008; 15(8): 1165 - 1170. [Abstract] [Full Text] [PDF]

				H. S Cox, M. Morrow, and P. W Deutschmann Long term efficacy of DOTS regimens for tuberculosis: systematic review BMJ, March 1, 2008; 336(7642): 484 - 487. [Abstract] [Full Text] [PDF]

				P. Nahid, L. C. Gonzalez, I. Rudoy, B. C. de Jong, A. Unger, L. M. Kawamura, D. H. Osmond, P. C. Hopewell, and C. L. Daley Treatment Outcomes of Patients with HIV and Tuberculosis Am. J. Respir. Crit. Care Med., June 1, 2007; 175(11): 1199 - 1206. [Abstract] [Full Text] [PDF]

				W. W. Yew and C. C. Leung Update in Tuberculosis 2006 Am. J. Respir. Crit. Care Med., March 15, 2007; 175(6): 541 - 546. [Full Text] [PDF]

				K. C. Chang, C. C. Leung, W. W. Yew, and C. M. Tam Standard anti-tuberculosis treatment and hepatotoxicity: do dosing schedules matter? Eur. Respir. J., February 1, 2007; 29(2): 347 - 351. [Abstract] [Full Text] [PDF]

				K. C. Chang, C. C. Leung, W. W. Yew, S. L. Chan, and C. M. Tam Dosing Schedules of 6-Month Regimens and Relapse for Pulmonary Tuberculosis Am. J. Respir. Crit. Care Med., November 15, 2006; 174(10): 1153 - 1158. [Abstract] [Full Text] [PDF]

				W. J. Burman, S. Goldberg, J. L. Johnson, G. Muzanye, M. Engle, A. W. Mosher, S. Choudhri, C. L. Daley, S. S. Munsiff, Z. Zhao, et al. Moxifloxacin versus Ethambutol in the First 2 Months of Treatment for Pulmonary Tuberculosis Am. J. Respir. Crit. Care Med., August 1, 2006; 174(3): 331 - 338. [Abstract] [Full Text] [PDF]

				I. M. Rosenthal, K. Williams, S. Tyagi, C. A. Peloquin, A. A. Vernon, W. R. Bishai, J. H. Grosset, and E. L. Nuermberger Potent Twice-Weekly Rifapentine-containing Regimens in Murine Tuberculosis Am. J. Respir. Crit. Care Med., July 1, 2006; 174(1): 94 - 101. [Abstract] [Full Text] [PDF]

				P. Nahid, M. Pai, and P. C. Hopewell Advances in the diagnosis and treatment of tuberculosis. Proceedings of the ATS, January 1, 2006; 3(1): 103 - 110. [Abstract] [Full Text] [PDF]

				I. M. Rosenthal, K. Williams, S. Tyagi, A. A. Vernon, C. A. Peloquin, W. R. Bishai, J. H. Grosset, and E. L. Nuermberger Weekly Moxifloxacin and Rifapentine Is More Active Than the Denver Regimen in Murine Tuberculosis Am. J. Respir. Crit. Care Med., December 1, 2005; 172(11): 1457 - 1462. [Abstract] [Full Text] [PDF]

				B. Nemery, W. W. Yew, R. Albert, C. Brun-Buisson, W. MacNee, F. J. Martinez, D. C. Angus, and E. Abraham Tuberculosis, Nontuberculous Lung Infection, Pleural Disorders, Pulmonary Function, Respiratory Muscles, Occupational Lung Disease, Pulmonary Infections, and Social Issues in AJRCCM in 2004 Am. J. Respir. Crit. Care Med., March 15, 2005; 171(6): 554 - 562. [Full Text] [PDF]

				A. A. Vernon and M. F. Iademarco In the Treatment of Tuberculosis, You Get What You Pay for... Am. J. Respir. Crit. Care Med., November 15, 2004; 170(10): 1040 - 1042. [Full Text] [PDF]