Errors in the treatment of tuberculosis in Baltimore
Errors in the treatment of tuberculosis in Baltimore
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DOI：
10.1378/chest.117.3.734
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发表时间：
2000-03-01
期刊：
影响因子：
9.6
通讯作者：
Chaisson, RE
中科院分区：
文献类型：
--
作者：
Rao, SN;Mookerjee, AL;Chaisson, RE
背景：不完全或不正确的抗生素治疗，特别是在抗结核（anti-TB）治疗的初始阶段，是获得性耐药和治疗失败的主要原因。我们通过不遵守推荐治疗方案的方式确定了马里兰州巴尔的摩市结核病患者抗结核治疗方案的错误程度，巴尔的摩市是一个发病率下降的城市。错误被定义为使用过少的药物或错误的药物，给予药物剂量不足，或处方治疗时间不足。方法：对1994年1月1日至1995年12月31日在巴尔的摩市报告的所有培养阳性肺结核患者进行回顾性分析。我们确定了人口统计信息、最初的抗结核方案、治疗剂量和持续时间、抗结核药物耐药性的历史或存在、注射药物或酒精滥用、艾滋病毒状况，以及治疗是由私人医生还是由巴尔的摩市卫生部门（BCHD）的结核病诊所提供的。结果：110例活动性肺结核患者中，有17例（15.4%）在控制病情的治疗中出现失误。34名私人治疗的患者中有13名（38%）在最初的抗结核方案中有一些错误，而BCHD结核病诊所治疗的76名患者中有4名（5.2%）有错误（p < 0.0001）。在其他方面，患者在年龄、性别、艾滋病毒状况、耐药特征和注射药物使用方面相似，而不管他们是否有错误的抗结核方案。结论：在低流行地区，私人医生在抗结核治疗处方中经常出现错误。为医生提供额外的教育资源和增加专家咨询的使用可能有助于改善结核病控制。
Background: Incomplete or incorrect antibiotic therapy, especially in the initial phase of antituberculosis (anti-TB) treatment, is a major cause of acquired drug resistance and treatment failure. We determined the extent of errors in anti-TB treatment regimens by way of nonadherence to recommended treatment protocols among patients with TB in Baltimore, MD, a city with declining rates of disease. An error was defined as using too few drugs or the wrong drugs, giving inadequate doses of drugs, or prescribing an inadequate duration of treatment.Methods: We reviewed the records of all patients with culture-positive, pulmonary TB reported in the city of Baltimore from January 1, 1994, to December 31, 1995. We determined demographic information, initial anti-TB regimen, doses and duration of therapy, history or presence of resistance to anti-TB drugs, injecting-drug or alcohol abuse, HIV status, and whether treatment was given by a private physician or by the Tuberculosis Clinic of the Baltimore City Health Department (BCHD).Results: Of the 110 cases of active pulmonary TB, 17 cases (15.4%) had errors in treatment for control of their current disease. Thirteen of 34 privately treated patients (38%) had some error in their initial anti-TB regimen, compared with 4 of 76 patients (5.2%) treated by the Tuberculosis Clinic of the BCHD (p < 0.0001). Patients were otherwise similar as determined by age, sex, HIV status, drug-resistance characteristics, and injecting-drug use, regardless of whether they had erroneous anti-TB regimens.Conclusion: In a low-prevalence area, private physicians make frequent errors in prescribing anti-TB therapy. Additional educational resources for physicians and increased use of expert consultation may contribute to improved TB control.