Supervised intermittent chemotherapy for pulmonary tuberculosis in a rural area of China

Trend of initial drug resistance of tubercle bacilli isolated from new patients with pulmonary tuberculosis and its correlation with the tuberculosis programme in Beijing

SETTING

The tuberculosis control programme of Beijing.

OBJECTIVE

To observe the trend of initial drug resistance of tubercle bacilli and to try to correlate it with the Beijing tuberculosis control programme.

DESIGN

Susceptibility testing of randomly collected isolates of positive sputum culture from new patients with pulmonary tuberculosis without a history of prior antituberculosis therapy, in 1962 and continuously since 1978. Collection of treatment data from the Beijing tuberculosis control programme.

RESULTS

The trend of initial drug resistance in Beijing began to decline in 1978. The Beijing tuberculosis treatment programme has been very successful, resulting in rapid reduction of prevalence of smear-positive cases.

CONCLUSION

It appears that the trend of initial drug resistance correlates with progress made in the implementation of the successful tuberculosis programme in Beijing. It is recommended that continuous observation of initial drug resistance be one of the indices of tuberculosis surveillance.

Tuberculosis control programme in Beijing

Since 1978 a new tuberculosis control programme based on modern concepts has been started in Beijing. The main goals of the programme were: (1) To prioritize the control of sources of infection; (2) to instigate fully supervised treatment (FST) for new smear-positive patients; (3) to extend services to the rural areas. A four-level network of tuberculosis control services has been organized both in urban and rural areas. Tuberculosis control has been integrated into rural primary health care. Coverage of FST among new smear-positive cases increased to 93% in 1990. A standard regimen, 1HS/11H2S2 has been used for initial treatment. A reserve regimen of RFP and EMB was added to those who failed to convert in 6 months. Since 1988 a 6-month intermittent short-course regimen has been introduced as standard regimen. Case-finding has been intensified since 1980 through symptomatics. Control of chronic excreters was achieved through FST of new smear-positive cases and fully supervised retreatment of old chronic cases. The new tuberculosis control programme has proved highly successful in controlling sources of infection. The prevalence of smear-positive pulmonary tuberculosis in Beijing during the national surveys in 1979, 1984-1985 and 1990 was 127, 56 and 16 per 100,000 respectively. The average annual reduction rate was 17%. This successful experiment has been recognized as a model for the whole country.