Results of directly observed short-course chemotherapy in 112,842 Chinese patients with smear-positive tuberculosis. China Tuberculosis Control Collaboration

Abstract

Background: Tuberculosis remains a substantial public health burden in China. The cure rate in treatment programmes has been about 50%. In 1991, a new project based on directly observed short-course chemotherapy was introduced. We report the results of the first 112,842 patients treated.

Methods: Patients with symptoms suggesting tuberculosis are referred by general health services to the tuberculosis county dispensary for physical examination and fluoroscopy. Those with suspicious findings submit three sputum samples for smear examination. Village doctors deliver free, directly observed therapy to all smear-positive patients on an outpatient basis. New cases are treated with streptomycin (750 mg), isoniazid (600 mg), pyrazinamide (2000 mg), and rifampicin (600 mg) every other day for 2 months, followed by 4 months of alternate-day isoniazid plus rifampicin. Previously treated patients receive streptomycin, isoniazid, pyrazinamide, rifampicin, and ethambutol (1250 mg) every other day for 2 months, followed by 6 months of isoniazid, rifampicin, and ethambutol. Patients are re-examined and smears are repeated at 2 months (then 3 months if still positive) and at 5 and 6 months (new cases) or 5 and 8 months (previously treated cases).

Findings: Nearly 1.6 million patients with suspected tuberculosis were referred for fluoroscopy between 1991 and 1994. 48% had suspicious findings on fluoroscopy and underwent sputum examination. 104,444 new smear-positive cases and 95,616 previously treated smear-positive cases have been diagnosed. Results of treatment for those enrolled up to the first quarter of 1994 show cure rates of 89.7% among new cases (55,213) and 81.1% among those previously treated (57,629). The failure rate in previously treated cases, an indicator of drug resistance, fell from 17.6% among 437 patients enrolled in 1991 to 6.2% among 7822 patients enrolled in the first quarter of 1994.

Interpretation: Our experience shows that high rates of compliance and cure can be achieved on a mass scale and in a short time by means of directly observed short-course chemotherapy and the WHO technical strategy for effective tuberculosis control.