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Ideas and Opinions |15 June 1995

Fixed-Dose Combinations of Antituberculous Medications To Prevent Drug Resistance

Thomas Moulding, MD; Asim K. Dutt, MD; Lee B. Reichman, MD, MPH

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Copyright ©2004 by the American College of Physicians
2004
  • From Harbor-University of California, Los Angeles, Medical Center, Torrance, California. Alvin C. York Veterans Administration Medical Center, Murfreesboro, Tennessee. New Jersey Medical School, Newark, New Jersey. Requests for Reprints: Thomas S. Moulding, MD, Division of Respiratory and Critical Care Physiology and Medicine, Harbor-University of California, Los Angeles, Medical Center, Torrance, CA 90501. Grant Support: By Cooperative Agreement 200-93-0636 from the Centers for Disease Control and Prevention; Tuberculosis Career Academic Award K07-h103015-01 from the Division of Lung Disease of the National Heart, Lung, and Blood Institute; and Research Consortium Grant 200-93-0690 from the Centers for Disease Control and Prevention.
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Increasing resistance to antituberculous drugs is a major concern. The usual measures recommended for dealing with this problem are 1) increased supervision of tuberculosis treatment in the form of directly observed therapy that seeks to eliminate or reduce interruptions in treatment and 2) the provision of an adequate number of drugs in the initial treatment of patients when the possibility of drug resistance is anticipated [1]. These recommendations are entirely appropriate because breaks in therapy lead to the development of drug resistance and preexisting drug resistance leads to additional drug resistance if adequate chemotherapy is not given. Unfortunately, a third equally important measure for preventing the emergence of drug resistance, the use of fixed-dose combinations of antituberculous drugs to avoid monotherapy, has been largely ignored in the United States.
It is has been well known from the earliest days of chemotherapy for tuberculosis that two or more drugs are required to retard the emergence of drug resistance [2]. Unfortunately, patients sometimes take only one drug (monotherapy) when more than one drug is prescribed. This occurs because of a temporary lack of a supply of one or more medications; mistakes in dispensing; patients' decisions to purchase only one medication to save money; supplies of one medication lasting longer than supplies of other medications; loss of one medication; misunderstandings; and patients' deliberate decisions to take only one drug because of perceived or real symptoms associated with the other drug, such as arthralgias with pyrazinamide or red urine with rifampin. When...
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Moulding T, Dutt AK, Reichman LB. Fixed-Dose Combinations of Antituberculous Medications To Prevent Drug Resistance. Ann Intern Med. 1995;122:951–954. doi: 10.7326/0003-4819-122-12-199506150-00010

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Published: Ann Intern Med. 1995;122(12):951-954.

DOI: 10.7326/0003-4819-122-12-199506150-00010

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