Published ahead of print on June 7, 2004, doi:10.1164/rccm.200401-095OC Am. J. Respir. Crit. Care Med., Volume 170, Number 5, September 2004, 561-566 A more recent version of this article appeared on September 1, 2004
Submitted on January 22, 2004 Tuberculosis Treatment Outcomes: Directly Observed Therapy Compared with Self-administered TherapyRobert M Jasmer1*,1 Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, San Francisco, CA, USA; Department of Medicine, University of California San Francisco, San Francisco, CA, USA, 2 Francis J. Curry National Tuberculosis Center, San Francisco, CA, USA; Tuberculosis Control Section, San Francisco Department of Public Health, San Francisco, CA, USA, 3 Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA, 4 Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, San Francisco, CA, USA; Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Francis J. Curry National Tuberculosis Center, San Francisco, CA, USA * To whom correspondence should be addressed. E-mail: rjasmer{at}itsa.ucsf.edu.
Effective treatment of tuberculosis requires adherence to a minimum of six months treatment with multiple drugs. To improve adherence and cure rates, directly observed therapy is recommended for the treatment of pulmonary tuberculosis. We compared treatment outcomes among all culture-positive patients treated for active pulmonary tuberculosis (n=372) in San Francisco County, California from 1998 through 2000. Patients treated by directly observed therapy at the start of therapy (n=149) had a significantly higher cure rate compared with patients treated by self-administered therapy (n=223) (the sum of bacteriologic cure and completion of treatment, 97.8% vs. 88.6%, p<0.002), and decreased tuberculosis-related mortality (0% vs.5.5%, p=0.002). Rates of treatment failure, relapse, and acquired drug resistance were similar between the two groups. Forty-four percent of patients who received self-administered therapy had risk factors for non-adherence and should have been assigned to directly observed therapy. We conclude that treatment plans that emphasize directly observed therapy from the start of therapy have the greatest success in improving tuberculosis treatment outcomes. Key words: pulmonary tuberculosis, directly observed therapy
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