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M9460327.TXT
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Document 0327
DOCN M9460327
TI Essentials of tuberculosis control for the practising physician.
Tuberculosis Committee, Canadian Thoracic Society.
DT 9408
SO Can Med Assoc J. 1994 May 15;150(10):1561-71. Unique Identifier :
AIDSLINE MED/94228398
AB OBJECTIVE: To recommend guidelines for the management of tuberculosis
(TB), particularly in high-risk groups including poor and homeless
people, aboriginal Canadians, immigrants from countries where TB is
highly prevalent and people with HIV infection. OPTIONS: Diagnosis,
pharmacotherapy, vaccination and chemoprophylaxis. OUTCOMES: Prevention
of infection and diagnosis and cure of TB. EVIDENCE: The evidence was
gathered in late 1992 from previous guidelines, recommendations by
specialist societies and new studies. VALUES: Evidence was categorized
into four levels: I, randomized clinical trials of therapeutic
interventions or prospective studies of diagnostic strategies; II,
case-control studies; III, retrospective descriptive studies; and IV,
consensus of the committee members and published statements. The
Tuberculosis Committee of the Canadian Thoracic Society comprises
experts in TB from across Canada. BENEFITS, HARM AND COSTS: The benefits
of early diagnosis and prompt initiation of therapy are well documented.
The cost effectiveness of antituberculous therapy in developing
countries is well documented. In developed countries chemoprophylaxis
has been shown to be cost effective, and directly observed chemotherapy
has recently been hypothesized to have economic benefits.
RECOMMENDATIONS: In the appropriate clinical setting, particularly when
patients are known to be at high risk of TB, clinicians should consider
TB, reserve body secretions for mycobacteriologic tests and conduct
other investigations such as chest radiography. Furthermore, if TB is
strongly suspected or confirmed by appropriate investigation the early
initiation of multi-drug therapy, including at least three first-line
drugs, is strongly recommended. If drug resistance is suspected a
regimen of four to five drugs, including at least two drugs with which
the patient has not been treated, should be started. If the strain is
found to be resistant to any of the drugs in the regimen appropriate
changes should be made. Chemoprophylaxis should be considered especially
in contacts with a recent significant reaction to the purified protein
derivative (PPD) skin test and in people known to be at risk of
reactivated TB infection, particularly those with HIV infection and a
significant PPD skin-test result. Vaccination with bacillus
Calmette-Guerin should be limited to high-risk groups, particularly
aboriginal Canadians living on reserves. VALIDATION: These
recommendations are based on a consensus of Canadian experts supported
by other specialist societies and reference groups. They have been
reviewed by the Standards Committee of the Canadian Thoracic Society.
SPONSOR: The Canadian Lung Association and the Tuberculosis Committee of
the Canadian Thoracic Society.
DE Algorithms Antitubercular Agents/ADVERSE EFFECTS/THERAPEUTIC USE BCG
Vaccine Human Risk Factors Tuberculin Test
Tuberculosis/*DIAGNOSIS/*DRUG THERAPY/PREVENTION & CONTROL GUIDELINE
JOURNAL ARTICLE PRACTICE GUIDELINE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).