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Nonadherence to Therapy
Nonadherence to prescribed treatment regimen complicates recovery. 25% of individuals receiving treatment for TB disease do not complete the program within 12 months.(7) Inadequate treatment leads to relapse, continued transmission and the development of drug resistance. If an individual refuses treatment for TB (and it is determined that he or she presents a threat of infecting others) legal intervention can be used to assure compliance.
Use of DOT for all patients is ideal. When a health care worker watches the patient take his or her medication, the incidence of disease relapse and drug resistance is significantly reduced. The health provider prescribes fixed-dose combinations when therapy is self-administered.
The length of treatment depends on the type of drugs used, drug susceptibility and the patient response. Most adults complete therapy in 6 to 9 months. HIV-infected individuals receive the same therapy but as mentioned earlier, may need to remain in treatment longer if response is slow. Extrapulmonary TB, with few exceptions, requires the same regimen as pulmonary TB.
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