By Price, Joyce
Insight on the News , Vol. 10, No. 48
Homeless patients who fail to adhere to their course of medication compound problem.
Federal health officials are pressing hospitals to adopt stricter guidelines and physicians in the field are seeking ways to improve patient compliance to contain the rise in drug-resistant TB cases in many U.S. cities.
Washington, for example, reported a total of 161 cases of TB to the federal Centers for Disease Control and Prevention, or CDC, in 1993, an increase of more than 10 percent. "Thirteen percent of the cases in that group were drug-resistant," says Dr. Thomas A. Cardella, director of the Infectious Disease Unit of the Georgetown University Medical Service at D.C. General Hospital. "That's a high level." Cardella expects D.C.'s high TB caseload to remain at current levels or rise. Nationally, TB cases declined 5.1 percent last year.
According to Cardella, the "leading cause" of drug-resistant TB has been the failure of patients to adhere to the required course of medication, which can be anywhere from six months to a year or longer. "I see a lot of failures," he says, mostly among the homeless population, with "proportionately more" alcoholics and drug abusers than the average patient population.
"Our patients often stay at the hospital," says Cardella. "It's expensive to keep patients in a hospital, but sometimes they have nowhere else to go."
After a 30-year decline in which TB all but disappeared in the United States, the caseload started rising in 1985. "From 1985 to 1992, there was a 20 percent increase in new cases," says CDC spokeswoman Kay Dolan.
Rifater, a new drug that combines the three main therapies for TB - rifampin, isoniazid and pyrazinamide - was approved in June by the Food and Drug Administration. …