PubMed · 1998 · 290 citations · 0 references
MedicinePharmacologyPharmacotherapyAntimicrobial ResistanceChemotherapyTuberculosis ControlAcquired ResistanceAntibacterial ResistanceChemotherapy ResistanceDrug ResistanceMechanisms Of Antimicrobial ResistanceTuberculosis PharmacotherapyDrug Resistance PatternsDrug Susceptibility AssaysMultidrug-resistant Tuberculosis TreatmentPhenotypic Drug Susceptibility TestingShort-course ChemotherapyTuberculosis Drug Resistance
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.