Directly observed therapy

Arranges for direct observation therapy with the patient and family. 

Twice weekly for 9 monthsc,d Directly observed therapy (DOT) must be used with twice-weekly dosing. B (II) B (II)... 

CHD Coronary heart disease DOT Directly observed therapy... 

Directly observed therapy A treatment method in which patients are under direct observation when they take their medication or receive their treatment. This method is designed to reduce the risk of treatment interruption and to ensure patient adherence. 

Measures to assure adherence, such as directly observed therapy, are important. 

The most serious problem with TB therapy is nonadherence to the prescribed regimen. The most effective way to ensure adherence is with directly observed therapy. 

Directly observed therapy (DOT) Adherence to the treatment regimen can be achieved by DOT, the gold standard. The health care provider watches the patient swallow each dose of medication. This allows for monitoring of the number of doses that an individual has taken. DOT may be given intermittently (2 to 3 times/week) or daily. 

Compliance It is recommended that directly observed therapy be practiced when patients are receiving antituberculosis medication. 

Because the effect of patient adherence on the outcome is much more critical, directly observed therapy (DOT) is strongly recommended for persons with HIV-1 infection to ensure that the patient takes every single prescribed dose. This protects against... 

A11 regimens administered 2 or 3 times a week must be used with directly observed therapy (DOT). 

DN diabetic nephropathy DOT directly observed therapy (method used commonly in the treatment of infectious disease such as sexually transmitted disease orTB) dppr dropper... 

Measures to assure adherence, such as directly observed therapy, are important. Patients with active disease should be isolated to prevent spread of the disease. 

In HIV-infected patients, isoniazid may be administered concurrently with nucleoside reverse transcriptase inhibitors, protease inhibitors, or nonnucleoside reverse transcriptase inhibitors Directly observed therapy must be used with twice-weekly dosing Not indicated for HIV-infected persons, those with fibrotic lesions on chest radiographs, or children... 

Five-day-a-week administration is always given by directly observed therapy. Rating for 5-day-per-week regimens is A (III). 

Directly observed therapy (DOT) (where a reliable person supervises each dose). In addition to the areas where it is obviously in the interest of patients that they be supervised, e.g. children, DOT is employed (even imposed) where free-living uncooperative patients may be a menace to the community, e.g. multiple-drug-resistant tuberculosis. 

Although compliance is often a concern with multiple drug therapy given for long periods, especially in the Developing World, directly observed therapy (DOT) has surprisingly not been proven to improve relapse rates in many trials. Combination therapy is assumed to improve compliance some commonly used combinations include Rifater (rifampicin, isoniazid plus pyrazinamide), and Rifinah or Rimactazid (rifampicin plus isoniazid). 

Drug malabsorption may contribute to the emergence of acquired drug resistance. It has been described in HIV-infected patients with advanced disease (37), and also in immunocompetent patients (38). Thus, in addition to the use of directly observed therapy to ensure compliance, it is advisable to monitor antimycobacterial drug concentrations routinely in such patients. Practical proposals for the choice of antituberculosis drugs in special circumstances, including drug resistance, have been made (39). 

Fujiwara PI, Larkin C, Frieden TR. Directly observed therapy in New York City. Clin Chest Med 1997 18 135-148. 

Reves R, Burman W, Dalton C, et al. A cost-effectiveness analysis of directly-observed therapy versus self-administered therapy for treatment of tuberculosis. Am J RespirCrit Care Med 1997 155(suppl) A33. 

An important problem in the chemotherapy of tuberculosis is bacterial resistance, primarily due to poor patient adherence. To prevent noncompliance and the attendant development of drug-resistant tuberculosis, directly observed therapy is advisable for most patients (i.e., a health care provider observes the patient take the medications 2—5 times weekly). 

For known resistance to isoniazid (or if the patient cannot tolerate the drug), the currently recommended regimen involves directly observed therapy (EXDT) with rifampin plus ethambutol plus pyrazinamide for 18 months (< 12 months after a negative sputum culture is reported). 

---