Authors: Craig, S.E.¹; Bettinson, H.¹; Sabin, C.A.²; Gillespie, S.H.³; Lipman, M.C.I.¹

Source: The International Journal of Tuberculosis and Lung Disease, Volume 13, Number 2, February 2009 , pp. 208-213(6)

Publisher: International Union Against Tuberculosis and Lung Disease

Abstract:

SETTING: Effective tuberculosis (TB) control requires prompt diagnosis of infectious cases through early suspicion of pulmonary TB in all subjects with suspected respiratory infection.

OBJECTIVE: To test our hypothesis that prior antibiotic treatment for presumed bacterial infection leads to a delay in diagnosing TB in a European country with low TB incidence.

DESIGN: Adults with culture-confirmed pulmonary TB at a single metropolitan centre were assessed for the impact of any previous antibiotic treatment on symptoms and the time to starting specific anti-tuberculosis treatment.

RESULTS: Of 83 patients, 42 (51%) received antibiotics prior to TB diagnosis, with symptomatic improvement reported in 20 of the 42 (48%) patients. This was unrelated to specific drug class. Although the median time to diagnosis in subjects receiving antibiotics was prolonged (P = 0.001), this was not predicted by treatment response. In 94% of cases, the initial chest radiograph was suggestive of TB infection.

CONCLUSION: Patients receiving antibiotics prior to TB confirmation experience a process-related delay in starting treatment. To minimise the risk of ongoing TB transmission, we propose that clinicians should include TB in their differential diagnosis and initiate simple, TB-focused investigations early on in the diagnostic process.

Keywords: pulmonary tuberculosis; antibiotics; delayed diagnosis

Document Type: Regular paper

Affiliations: 1: Department of Respiratory Medicine, Royal Free Hospital, London, UK 2: Department of Medical Statistics and Epidemiology, Royal Free & University College Medical School, London, UK 3: Centre for Medical Microbiology, Royal Free & University College Medical School, London, UK

Publication date: 2009-02-01

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• 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.

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