title: The management of pulmonary tuberculosis in adults notified in England and Wales in 1988. The British Thoracic Society Research Committee and the Medical Research Council Cardiothoracic Epidemiology Group.
abstract: A survey was conducted of the management of adult patients with pulmonary tuberculosis notified in England and Wales in the first 6 months of 1988. Its main aim was to record the current usage of anti-tuberculosis drugs. Information was obtained on 1026 patients (91% of those surveyed), of whom 97% were prescribed rifampicin and isoniazid as principal components of their chemotherapy. Pyrazinamide was prescribed to 80%, which represents a substantial increase on the 19% recorded in a similar survey of patients notified in 1983. Adverse reactions requiring modification of therapy occurred in 15.4% of the 332 patients starting treatment with rifampicin (R), isoniazid (H), pyrazinamide (Z) and ethambutol (E), and although the percentages were slightly lower in those who started treatment with the other main combinations of drugs, namely HRZ (14.1% of 355 patients) and HRE (12.8% of 125 patients), the differences were clinically unimportant and did not reach statistical significance. Of the patients who were prescribed pyrazinamide, only 29% received therapy approximating to the schedule now recommended as standard in the U.K., namely 2 months of triple or quadruple therapy including pyrazinamide, followed by rifampicin and isoniazid for 4 months more. This low percentage reflects the wide variation in treatment schedules and the fact that many patients continued on therapy for 9 months or more. The findings of this survey highlight the non-uniformity of prescribing practices and some of the difficulties of ensuring that patients with pulmonary tuberculosis complete an appropriate course of therapy.
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004739:England; D006801:Humans; D007538:Isoniazid / Q000008:administration & dosage; D011718:Pyrazinamide / Q000008:administration & dosage; D012293:Rifampin / Q000008:administration & dosage; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy*; D014852:Wales
chemical_list: D000995:Antitubercular Agents; D011718:Pyrazinamide; D007538:Isoniazid; D012293:Rifampin