To the Editor: Directly observed therapy for tuberculosis hasbeen advocated as a way to improve compliance and control theemergence of drug resistance.1,2 We recently cared for two patientswith human immunodeficiency virus (HIV) infection who were receivingtherapy under direct observation when they relapsed with drug-resistantisolates of Mycobacterium tuberculosis, presumably due to subtherapeuticdrug levels caused by malabsorption.
Patient 1, a 30-year-old man, began receiving directly observedtherapy in December 1993; his therapy consisted of isoniazid(300 mg), rifampin (600 mg), and pyrazinamide (800 mg) dailyfor ileocecal and pulmonary tuberculosis. At that time tuberculosisisolates from . . . [Full Text of this Article]
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