The risk-benefit analysis of isoniazid preventive therapy in areas of high isoniazid resistance by Sterling et al1 that appeared in the August 7/21, 1995, issue of the ARCHIVES is welcome and badly needed. However, because of certain assumptions, I believe that the authors overstated the justification for giving isoniazid preventive therapy to many patients and probably understated it for others.
The authors failed to include the health concern factor when estimating the case-fatality rate. Most deaths that result from tuberculosis (TB) occur for two reasons: (1) patient failure to seek medical care until the disease is too far advanced to be cured and (2) physician failure either to make the diagnosis or to manage the patient properly. Those individuals who seek medical care too late to be cured tend to be homeless, mentally disturbed, and/or alcoholic. Support for this assertion is provided by a review of TB deaths at
Moulding T. Isoniazid Preventive Therapy in Areas of High Isoniazid Resistance. Arch Intern Med. 1996;156(6):685–686. doi:10.1001/archinte.1996.00440060115019
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