Document 0446
 DOCN  M9550446
 TI    Empiric antituberculosis treatment: benefits for earlier diagnosis and
       treatment of tuberculosis.
 DT    9505
 AU    Anglaret X; Saba J; Perronne C; Lacassin F; Longuet P; Leport C; Vilde
       JL; Service des Maladies Infectieuses et Tropicales, Hopital;
       Bichat-Claude Bernard, Paris, France.
 SO    Tuber Lung Dis. 1994 Oct;75(5):334-40. Unique Identifier : AIDSLINE
       MED/95143518
 AB    SETTING: Tuberculosis may be diagnosed too late, especially in
       HIV-infected patients, with consequences on bacillus transmission and
       survival. Empiric antibuberculosis treatment (EATT) may be started
       before diagnosis of tuberculosis is confirmed. As rifampicin is a broad
       spectrum antibiotic, EATT including rifampicin may be effective in
       infections other than tuberculosis, leading to misdiagnosis. OBJECTIVE:
       To define the efficiency criteria of EATT with or without rifampicin.
       DESIGN: Between 1988 and 1991, 20 febrile patients with suspected
       tuberculosis (including 15 who were HIV-positive) were started on EATT
       in the absence of bacteriological or histological proof of tuberculosis.
       10 patients (50%) received a 4-drug non-specific EATT including
       rifampicin, isoniazid, pyrazinamide and ethambutol, and 10 (50%),
       received a 3-drug specific EATT without rifampicin. RESULTS: In 10
       patients (50%), the diagnosis of tuberculosis was confirmed by positive
       cultures within a mean of 32 days (15-57 days) after the beginning of
       EATT (group TB 1). Of the 10 patients whose cultures remained negative,
       4 (20%) became afebrile and showed improvement under EATT (group TB 2),
       and 6 (30%) remained febrile and did not improve (group No TB). Patients
       from groups TB 1 and TB 2 became afebrile within a mean of 11 days (1-54
       days). This delay was not different between patients receiving specific
       or non-specific EATT. In patients receiving specific EATT, rifampicin
       was added to the initial 3-drug treatment after resolution of fever.
       CONCLUSION: EATT appears to be a useful method for rapid presumptive
       diagnosis and treatment of tuberculosis.
 DE    Adult  Antitubercular Agents/*ADMINISTRATION & DOSAGE/ADVERSE EFFECTS
       AIDS-Related Opportunistic Infections/DIAGNOSIS/*DRUG THERAPY  Body
       Weight  Drug Administration Schedule  Drug Therapy, Combination
       Ethambutol/THERAPEUTIC USE  Female  Fever/MICROBIOLOGY  Follow-Up
       Studies  Human  Isoniazid/THERAPEUTIC USE  Male  Middle Age
       Pyrazinamide/THERAPEUTIC USE  Rifampin/THERAPEUTIC USE  Time Factors
       Treatment Outcome  Tuberculosis/DIAGNOSIS/*DRUG THERAPY  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).