How drug resistance emerges as a result of poor compliance during short course chemotherapy for tuberculosis - PubMed (original) (raw)

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How drug resistance emerges as a result of poor compliance during short course chemotherapy for tuberculosis

D A Mitchison. Int J Tuberc Lung Dis. 1998 Jan.

Abstract

Objective: To explore mechanisms by which drug resistance might arise as a result of poor compliance during short course chemotherapy.

Design: Four theoretical mechanisms are first described.

Results: Examples of the way the mechanisms probably operate are taken from: 1) a study of once-weekly chemotherapy with streptomycin and isoniazid, and 2) the pattern of drug susceptibility in cultures from patients who relapsed after the end of treatment.

Conclusion: Good compliance is vitally important. The value of a fourth drug in the initial phase of chemotherapy in preventing resistance is questioned. An explanation for mono-resistance to rifampicin in patients with the acquired immune deficiency syndrome (AIDS) is suggested.

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