Six-months versus nine-months chemotherapy for tuberculosis of lymphnodes: preliminary results*
One-hundred and ninety-nine patients with peripheral lymph node tuberculosis were randomized to treatment with either E2H9R9, Z2H9R9 or Z2H6R6 regimens (E, ethambutol; H, isoniazid; R, rifampicin; Z, pyrazinamide; numbers denote duration of therapy in months). One-hundred and thirty-three patients were diagnosed by aspiration/biopsy leaving residual nodes, 44 were diagnosed after excision of the palpable nodes and 22 were diagnosed on clinical grounds supported by a strongly positive tuberculin test. Treatment was completed as planned by 157 patients. Eight patients required aspirations after commencing chemotherapy, seven on ethambutol and one on pyrazinamide (P = 0005). There was no statistically significant difference between the regimens in speed of resolution of nodes, or in the percentage with residual nodes at the end of treatment, or inthe numbers developing fluctuation or sinuses. Follow-up to 30 months from commencement of treatment continues in order to establish relapse rates for the regimens.
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Cited by (36)
Extrapulmonary tuberculosis
2015, Revue de Pneumologie CliniqueChaque année, plus de huit millions de personnes développent une tuberculose et près d’un million et demi en meurent. Les tuberculoses extrapulmonaires connaissent un regain d’intérêt en raison d’une augmentation inexpliquée de leur fréquence relative. N’importe quel organe peut être atteint, mais ce sont les ganglions et la plèvre qui sont, d’assez loin, les localisations extrapulmonaires les plus fréquentes. Le diagnostic est souvent difficile, et repose sur la clinique, l’imagerie et les analyses microbiologiques et anatomopathologiques. Les lésions étant paucibacillaires et les prélèvements étant dans la majorité des cas difficiles à obtenir, le diagnostic est souvent purement présomptif. Les techniques d’amplification nucléique, rapides et spécifiques, ont considérablement facilité le diagnostic de certaines formes de tuberculose extrapulmonaire. Toutefois, leur sensibilité est insuffisante et un test négatif ne permet pas d’éliminer le diagnostic. Le traitement fait appel aux mêmes molécules que pour les formes pulmonaires, mais sa durée est de neuf à 12 mois pour les formes neuroméningées. Ces dernières sont, avec les localisations péricardiques, une indication des corticoïdes. Une chirurgie complémentaire est nécessaire dans certaines formes compliquées.
Each year, there are more than eight million new cases of tuberculosis and 1.3 million deaths. There is a renewed interest in extrapulmonary forms of tuberculosis as its relative frequency increases. Among extrapulmonary organs, pleura and lymph nodes are the most common. Their diagnosis is often difficult and is based on clinical, radiological, bacteriological and histological findings. Extrapulmonary lesions are paucibacillary and samplings, in most cases, difficult to obtain, so diagnosis is often simply presumptive. Nucleic acid amplification tests, which are fast and specific, have greatly facilitated the diagnosis of some forms of extrapulmonary tuberculosis. However, their sensitivity is poor and a negative test does not eliminate the diagnosis. Treatment is the same as for pulmonary forms, but its duration is nine to 12 months for central nervous system and for bone tuberculosis. Corticosteroids are indicated in meningeal and pericardial localizations. Complementary surgery is used for certain complicated forms.
Tuberculosis treatment
2015, Revue de Pneumologie CliniqueLe but de cette mise au point est d’établir une approche pratique dans la prise en charge thérapeutique de la tuberculose dans sa forme latente et active. La plupart des patients atteints de tuberculose suivront l’un des schémas thérapeutiques antituberculeux standard recommandés par l’OMS ou par des sociétés savantes et selon la catégorie de malade. Tous ces schémas sont composés d’une association de quatre médicaments essentiels appelés « antituberculeux du premier groupe » : isoniazide, rifampicine, pyrazinamide et éthambutol. La streptomycine peut remplacer dans certains cas l’éthambutol. Cette phase initiale de traitement intensif est suivie d’une phase de consolidation prolongée sur plusieurs mois. Les médicaments doivent être administrés le matin à jeun une heure avant le repas. Le traitement de l’infection tuberculeuse latente est un volet important dans les programmes de lutte car il permet de réduire l’évolution vers la tuberculose active.
The aim of this article is to give practicing physicians a practical approach to the treatment of latent and active tuberculosis. Most patients follow TB standard treatment recommended by WHO that depend on category of patient. It is a combination of four essential tuberculosis drugs of the first group: isoniazid, rifampicin, pyrazinamid and ethambutol; in some cases streptomycin can replace ethambutol. This initial phase of intensive treatment is followed by a consolidation phase. Drugs should be administered in the morning on an empty stomach one hour before meals. Treatment of latent tuberculosis (TB) infection is an important component of TB control programs. Preventive treatment can reduce the risk of developing active TB.
Treatment duration of extra-pulmonary tuberculosis: 6months or more? TB-INFO database analysis
2012, Revue de Medecine InterneLa durée recommandée du traitement de la tuberculose pulmonaire est de six mois. Concernant la tuberculose extrapulmonaire, les pratiques diffèrent, la durée du traitement dépendant de la localisation et du statut vis-à-vis de l’infection VIH. L’objectif de ce travail était de réaliser une étude rétrospective d’une cohorte de patients atteints de tuberculose exclusivement extrapulmonaire, afin d’en décrire les principales caractéristiques épidémiologiques et de comparer les patients ayant eu un traitement de six mois à ceux ayant eu un traitement de plus de six mois, en évaluant les pratiques de deux centres.
Cette étude rétrospective a été réalisée sur une cohorte de 210 patients atteints de tuberculose extrapulmonaire entre janvier 1999 et décembre 2006 dans deux hôpitaux du nord-est Parisien. Ces patients étaient traités par quadrithérapie durant deux mois, suivi d’une bithérapie. Les données de 143 patients étaient analysables 24 mois après la fin du traitement. Soixante-dix-sept patients étaient traités six mois, 66 plus de six mois. Les caractéristiques de chaque groupe ont été comparées en analyse uni- et multivariée. Le critère principal était le taux de rechute ou d’échec de traitement au bout de 24 mois de suivi après la fin du traitement pris complètement.
Aucune rechute n’a été constatée 24 mois après la fin du traitement dans les deux groupes de patients. En analyse univariée, les atteintes ganglionnaires étaient plus souvent traitées six mois comparativement aux autres localisations de tuberculose extrapulmonaire (respectivement 61 % versus 40,9 % ; p = 0,02) ; la durée de traitement était associée aux pratiques de chaque service (79,2 % traités six mois dans un centre hospitalier, versus 20,7 % dans l’autre centre hospitalier, p < 0,001) ; les patients vivant en résidence individuelle étaient plus souvent traités six mois que les patients vivant en résidence collective (24,2 % versus 10,3 %, p = 0,042). En analyse multivariée, seuls le lieu de suivi (p = 0,046), le sexe (p = 0,007) et la résidence privée (p = 0,02) étaient retrouvés significativement différents dans chaque groupe de durée de traitement. En revanche, la localisation de la tuberculose n’était pas significativement différente dans chacun des groupes.
Le pronostic des patients ayant une tuberculose extrapulmonaire (hors tuberculose méningée) traités six mois n’est pas moins bon que celui des patients traités plus de six mois, ce qui est en accord avec les recommandations nationales et internationales.
The recommended duration of pulmonary tuberculosis therapy is 6 months. For extrapulmonary tuberculosis, treatment duration depends on tuberculosis involvement and HIV status. The objective of this study was to describe the main characteristics of a cohort of extrapulmonary tuberculosis patients, to compare patients with a 6-month treatment to those with more than a 6-month treatment, and to analyze the compliance of medical centres with recommended duration of treatment.
A retrospective cohort study of 210 patients with extrapulmonary tuberculosis was carried from January 1999 to December 2006 in two hospitals in the north-east of Paris. These patients were treated with quadruple therapy during two months, followed by dual therapy during 4 months (n = 77) or more (n = 66). The characteristics of each group were compared by uni- and multivariate analysis. The primary endpoint was the rate of relapse or treatment failure at 24-month follow-up after treatment completion.
No relapse was observed after 24 months of follow-up after the end of treatment in the two groups. In univariate analysis, patients with lymph node tuberculosis were more often treated for 6 months than at other sites of tuberculosis (respectively 61% versus 40.9%; P = 0.02); the decision of treatment duration was related to medical practices (79.2% treated 6 months in one hospital versus 20.7% in the other, P < 0.001); patients living in private residence were more often treated during 6 months than patients living in residence (24.2% versus 10.3%, P = 0.042). In multivariate analysis, only hospital (P = 0.046), sex (P = 0.007) and private residence were significantly different in each group.
A period of 6 months seems to be sufficient to treat extrapulmonary tuberculosis (except for neuromeningeal localization).
Extrapulmonary tuberculosis
2012, Revue des Maladies RespiratoiresLes tuberculoses extrapulmonaires (TBE) représentent un pourcentage croissant de toutes les formes de tuberculose, atteignant 20 à 40 % d’entre elles selon les séries. La proportion de TBE semble plus élevée chez les sujets de race noire, les femmes et les patients immunosupprimés ; une proportion non négligeable des sujets atteints ont une radiographie du thorax normale lors du diagnostic. Les atteintes les plus fréquentes sont ganglionnaires, pleurales ou ostéoarticulaires. Les tuberculoses digestives, urogénitales ou méningées ne sont pas rares et leur diagnostic est souvent différé par un diagnostic différentiel large et par des tests diagnostiques qui manquent de sensibilité, y compris les cultures et les tests d’amplification génique. La présentation clinique des TBE est décrite de même que le rendement des divers tests à disposition. Les recommandations thérapeutiques internationales sont rappelées ainsi que des recommandations pratiques relatives aux différentes présentations cliniques.
Extrapulmonary tuberculosis represents an increasing proportion of all cases of tuberculosis reaching 20 to 40% according to published reports. Extrapulmonary TB is found in a higher proportion of women, black people and immunosuppressed individuals. A significant proportion of cases have a normal chest X-Ray at the time of diagnosis. The most frequent clinical presentations are lymphadenitis, pleuritis and osteoarticular TB. Peritoneal, urogenital or meningeal tuberculosis are less frequent, and their diagnosis is often difficult due to the often wide differential diagnosis and the low sensitivity of diagnostic tests including cultures and genetic amplification tests. The key clinical elements are reported and for each form the diagnostic yield of available tests. International therapeutic recommendations and practical issues are reviewed according to clinical presentation.
The chemotherapy of tuberculous lymphadenopathy in children
2010, TuberculosisCitation Excerpt :These studies are briefly summarized in Table 1. In eight papers recording the results of six studies32–39 the subjects had been randomized to their respective treatment groups. The paper of Ormerod described a retrospective analysis of two groups of patients40; in two papers the manner of allocation to treatment group was unclear41,42.
The chemotherapy of tuberculous lymphadenopthy, the commonest form of extra-pulmonary tuberculosis, is reviewed and a recommendation made for the treatment of this condition in children. Fifteen papers were identified recording the treatment and follow-up of 1133 adults and children with six-month isoniazid and rifampicin based regimens. In 32 (2.8%) cases treatment was recommenced, but in only one case was relapse microbiologically confirmed and in a further four histology was compatible with tuberculosis. Four studies enrolling 484 adults and children, record the follow-up of patients receiving 6–18 months treatment with INH and RMP based regimens; treatment was recommenced in 24 (5%), but in no case was relapse confirmed microbiologically. Five papers describe the treatment and follow-up of 246 adults and children receiving nine-month INH and RMP based regimens and record the recommencement of treatment in 4 (1.6%) cases, but in no case was relapse confirmed microbiologically. Four controlled studies failed to show any advantage for treatment regimens longer than six months. Paradoxical recurrence and worsening of clinical features was common during and following all regimens being recorded in from 3 to20% of patients. Very seldom were these events accompanied by evidence of culture of Mycobacterium tuberculosis to confirm microbiological failure to respond or relapse. Tuberculous lymphadenopathy in children can be safely treated with six months of INH and RMP with PZA given for the first two months and accompanied by EMB in areas with a high prevalence of drug resistance. Every effort should be made to confirm the diagnosis and possible relapses microbiologically.
Tuberculosis and other mycobacterial infections
2010, Antibiotic and Chemotherapy: Expert Consult
- *
This study was organized by a subcommittee comprizing: Dr I. A. Campbell (Chairman), Dr L. P. Ormerod* (Coordinator and compiler of report), Dr J. A. R. Friend, Dr P. A. Jenkins and Dr R.J. Prescott
- *
To whom correspondence should be addressed at: Royal Infirmary, Blackburn, Lanes BB2 3LR.