title: Impact of empiric antibiotics and chest radiograph on delays in the diagnosis of tuberculosis.
abstract: METHODS
  Maryland Department of Health and Mental Hygiene, Division of Tuberculosis (TB) Control.
  
  
  OBJECTIVE
  To assess the implications of antibiotic treatment of presumed community-acquired pneumonia (CAP) on delays in the diagnosis of TB, and to assess the frequency with which chest radiographs (CXRs) were utilized before a diagnosis of pneumonia or pulmonary TB was made.
  
  
  METHODS
  A nested case-control study within a prospective study conducted to assess factors associated with delays in the diagnosis of TB.
  
  
  RESULTS
  Cases (n = 85; 54%) were patients who received antibiotics for non-TB diagnoses/indications prior to TB diagnosis, and controls (n = 73; 46%) were patients who had initially received TB therapy. Median health care delay for cases was 39 days vs. 15 days (P < 0.01) for controls. Median antibiotic delay was similar among all antibiotic classes. Of 54 patients who did not have a CXR at their first health care visit, 41 (79%) received empiric antibiotics, compared to 44/105 (42%) who had a CXR (P < 0.01). Only 31/54 (57%) patients initially diagnosed with CAP had a CXR at the time of diagnosis.
  
  
  CONCLUSIONS
  More widespread use of CXR when diagnosing CAP should reduce delays in diagnosing TB, and the unnecessary use of antibiotics.
authors.affiliation: School of Medicine, Johns Hopkins University, Baltimore, Maryland 21231, USA. jgolub@jhmi.edu
authors.forename: J E
authors.initials: JE
authors.lastname: Golub
authors.forename: S
authors.initials: S
authors.lastname: Bur
authors.forename: W A
authors.initials: WA
authors.lastname: Cronin
authors.forename: S
authors.initials: S
authors.lastname: Gange
authors.forename: T R
authors.initials: TR
authors.lastname: Sterling
authors.forename: B
authors.initials: B
authors.lastname: Oden
authors.forename: N
authors.initials: N
authors.lastname: Baruch
authors.forename: G W
authors.initials: GW
authors.lastname: Comstock
authors.forename: R E
authors.initials: RE
authors.lastname: Chaisson
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis / Q000188:drug therapy; D013902:Radiography, Thoracic; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*
chemical_list: D000900:Anti-Bacterial Agents