Impact of empiric antibiotics and chest radiograph on delays in the diagnosis of tuberculosis.
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.
Golub
J E
JE
School of Medicine, Johns Hopkins University, Baltimore, Maryland 21231, USA. jgolub@jhmi.edu
Bur
S
S
Cronin
W A
WA
Gange
S
S
Sterling
T R
TR
Oden
B
B
Baruch
N
N
Comstock
G W
GW
Chaisson
R E
RE
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*
D000900:Anti-Bacterial Agents