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.

The control of chronic infectious patients with pulmonary tuberculosis in a rural area of China.

The aim of this study was to reduce the prevalence of chronic infectious cases (CIC) in a rural area of China by fully supervised chemotherapy of newly diagnosed smear-positive cases and by reducing the number of existing old CIC through fully supervised retreatment. From 1980 to 1985, 83.3% of 1828 new, smear-positive cases were given fully supervised chemotherapy. In 1980, 95.2% of 565 old CIC started fully supervised retreatment. The prevalence of CIC had dropped from 40.5/100,000 in 1980 to 6.7/100,000 by the end of 1986.

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

In order to ensure regularity of ambulatory treatment of new cases of pulmonary tuberculosis, a fully supervised intermittent chemotherapy regimen was tried in two rural counties of Beijing. The bare-foot doctors of the village health co-operatives were designated to administer and supervise treatment. The regimen consisted of isoniazid and streptomycin daily for 1 month, then every 3 days for 5 months and then every 5 days for a total of 12 or 18 months. For smear-negative cases the daily phase was omitted. The compliance rate among 229 patients in 1 year was 99.4%. The sputum conversion rate among 104 cases harbouring sensitive bacilli was 95.2%. Discontinuation of the regimen due to side-effects as necessary in 3 cases (1.3%). Since 1979, this treatment programme has been adopted in the whole rural area of Beijing, and the coverage rate among newly diagnosed smear-positive cases in 1983 reached 90%. A reserve regimen consisting of rifampicin and ethambutol for patients who do not convert their sputum after 6 months of treatment with isoniazid and streptomycin was added. The overall conversion rate achieved in 1981 was 97.8%. The average overall cost of drugs for each patient treated in this treatment programme was 49 yuan (RMB), about $24.00 U.S.