Short-course therapy of pulmonary tuberculosis: doctor's compliance.
OBJECTIVE
The present study, conducted from 1986 to 1991, investigated the accuracy of treatment monitoring performed by practitioners in the out-patient treatment of pulmonary tuberculosis.


METHODS
All patients with smear or culture positive pulmonary tuberculosis, receiving 6-month short-course chemotherapy with Isoniazid (H), Rifampicin (R) and Pyrazinamide (Z), were included. Treatment had been initiated either in our unit, or shortly before, with discharge after an average time of 8 weeks. Practitioners were sent a flow sheet advising how to perform standardized ambulatory controls.


RESULTS
Forty-three patients were included in the study, four of whom did not visit their practitioner after discharge. It must be assumed that they did not complete treatment. The average follow-up time of the remaining 39 patients was 159 weeks. In 13 cases the treatment was prolonged without obvious reason. For four patients who had not converted to a negative sputum culture at discharge, negativity was never been proven thereafter. Objective means of assessing patient compliance by H-urine strip testing were undertaken only in three cases. X-ray controls were performed adequately in 44.4% of the cases. By contrast monthly checks of liver enzymes had been done only in 23.1% of the patients.


CONCLUSIONS
We conclude that even a highly standardized protocol of short-course tuberculosis treatment requires a certain level of experience and compliance on the part of the practitioner. We accordingly recommend that every case of pulmonary tuberculosis should be reviewed at least twice by a chest physician.
Rothe
T B
TB
Luzerner Hoehenklinik Montana, Switzerland.
Karrer
W
W
D000328:Adult; D000437:Alcoholism / Q000150:complications; D000553:Ambulatory Care / Q000592:standards; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002983:Clinical Competence; D004338:Drug Combinations; D005194:Family Practice / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011718:Pyrazinamide / Q000627:therapeutic use; D012293:Rifampin / Q000627:therapeutic use; D013557:Switzerland; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000188:drug therapy*
D000995:Antitubercular Agents; D004338:Drug Combinations; D011718:Pyrazinamide; D007538:Isoniazid; D012293:Rifampin