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Free Content Impact of empiric antibiotics and chest radiograph on delays in the diagnosis of tuberculosis

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Abstract:

SETTING: Maryland Department of Health and Mental Hygiene, Division of Tuberculosis (TB) Control.

OBJECTIVES: To assess the implications of antibiotic treatment of presumed community-acquired pneumonia (CAP) on delays in the diagnosis of TB, and to assess the frequency with which chest radiographs (CXRs) were utilized before a diagnosis of pneumonia or pulmonary TB was made.

DESIGN: A nested case-control study within a prospective study conducted to assess factors associated with delays in the diagnosis of TB.

RESULTS: Cases (n = 85; 54%) were patients who received antibiotics for non-TB diagnoses/indications prior to TB diagnosis, and controls (n = 73; 46%) were patients who had initially received TB therapy. Median health care delay for cases was 39 days vs. 15 days (P < 0.01) for controls. Median antibiotic delay was similar among all antibiotic classes. Of 54 patients who did not have a CXR at their first health care visit, 41 (79%) received empiric antibiotics, compared to 44/105 (42%) who had a CXR (P < 0.01). Only 31/54 (57%) patients initially diagnosed with CAP had a CXR at the time of diagnosis.

CONCLUSION: More widespread use of CXR when diagnosing CAP should reduce delays in diagnosing TB, and the unnecessary use of antibiotics.

Keywords: antibiotics; community-acquired pneumonia; delayed diagnosis; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Tuberculosis Division, Maryland Department of Health & Mental Hygiene, Baltimore, Maryland, USA 2: Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA 3: School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA 4: School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA; and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA

Publication date: 2005-04-01

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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