Pyrazinamide use as a method of estimating under-reporting of tuberculosis.
OBJECTIVE
To develop a method of validating the notification of active tuberculosis by physicians in the Netherlands.


METHODS
The chemotherapeutic agent pyrazinamide was used as a marker for the occurrence of tuberculosis. On the basis of defined daily doses (DDD) of pyrazinamide dispensed to out-patients, an estimate was made of the number of patients with tuberculosis in the Netherlands in the period 1994-1998. DDD is a technical unit of measurement and does not necessarily reflect the recommended or actual dose used. Usually it is based on the average dosage per day for the main indication in adults with normal organ function. The Dutch Drug Information Project (GIP) of the Health Care Insurance Board (CVZ) provided the DDD data. Based on the notification of tuberculosis patients to the Netherlands Tuberculosis Register (NTR) we calculated how much pyrazinamide (measured in DDDs) these patients would have used depending on their body weight.


RESULTS
The number of DDDs prescribed according to the GIP pharmacy records differed by only 8% from the number of DDDs calculated on the basis of notification to the NTR; 6889 patients should have been registered instead of 6349.


CONCLUSIONS
The close correlation between the use of pyrazinamide as measured by the GIP and NTR provides strong evidence that in the Netherlands tuberculosis is reported in conformity with the guidelines for notifiable diseases. The method was simple to apply and may deserve follow-up in other countries.
van Loenhout-Rooyackers
J H
JH
GGD Regio Nijmegen (Municipal Health Services), The Netherlands. jloenhout@ggd-nijmegen.nl
Leufkens
H G
HG
Hekster
Y A
YA
Kalisvaart
N A
NA
D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage*; D018563:Disease Notification / Q000379:methods* / Q000706:statistics & numerical data*; D006801:Humans; D009426:Netherlands / Q000453:epidemiology; D011718:Pyrazinamide / Q000008:administration & dosage*; D012042:Registries; D014376:Tuberculosis / Q000188:drug therapy* / Q000453:epidemiology*
D000995:Antitubercular Agents; D011718:Pyrazinamide