Interventions for Tuberculosis Control and Elimination
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Because of the increasing prevalence of HIV infection among tuberculosis patients in East Africa, thioacetazone could no more be given responsibly and had to be replaced by an alternative, the choice of which was ethambutol rather than rifampicin because of fear of acquisition of rifampicin resistance during the un-observed continuation phase. This change was operationally imperative but it weakened the cascade of regimens.
If thioacetazone is replaced by ethambutol, patients with initial isoniazid resistance failing on treatment will have acquired ethambutol resistance. The re-treatment regimen provides now effective rifampicin monotherapy in the continuation phase. Because of the low frequency of mutations that confer resistance to rifampicin and the usually low bacillary load that is expected after the intensive phase, this may not carry a great danger but the potential certainly exists as will be shown.
