Monedero I, Caminero JA. Evidence for promoting fixed-dose combination drugs in tuberculosis treatment and control: a review. Int J Tuberc Lung Dis. 2011 Apr;15(4):433-9.
In this week’s article, Monedero and Caminero conduct a critical review of research on the use of fixed-dosed combinations (FDCs) for tuberculosis with the conclusion that FDCs should continue to be promoted and recommended. FDCs combine two or more drugs in a regimen into one single fixed-dose which reduces the pill burden, which increases the chances that patients will adhere to treatment over longer periods.
The use of FDCs remains low in TB programs. The authors site the following reasons for utilizing a single pill instead of many separate pills:
1) Avoidance of drug selection by the patient which often leads to monotherapy,
2) Prevention of prescription errors,
3) Increased patient adherence due to reduced pill burden,
4) Improvements in drug handling and deliver and ultimately,
5) Improvements in TB outcomes and prevention of drug resistance.
A literature review was performed in 2010 and 15 articles were identified that were published between 1987 and 2009. The publications supported the hypothesis that FDCs have similar efficacy as use of single drugs together. Only one study addressed the relevancy of FDCs in preventing drug-resistance. It was noted that there were no published data on use of FDCs in the private sector. Based on their review, the authors felt that the FDCs should be promoted to increase low uptake, especially where DOTS is not fully implemented.
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