title: Improved consistency in dosing anti-tuberculosis drugs in Taipei, Taiwan.
abstract: BACKGROUND
  It was reported that 35.5% of tuberculosis (TB) cases reported in 2003 in Taipei City had no recorded pre-treatment body weight and that among those who had, inconsistent dosing of anti-TB drugs was frequent. Taiwan Centers for Disease Control (CDC) have taken actions to strengthen dosing of anti-TB drugs among general practitioners. Prescribing practices of anti-TB drugs in Taipei City in 2007-2010 were investigated to assess whether interventions on dosing were effective.
  
  
  RESULTS
  Lists of all notified culture positive TB cases in 2007-2010 were obtained from National TB Registry at Taiwan CDC. A medical audit of TB case management files was performed to collect pretreatment body weight and regimens prescribed at commencement of treatment. Dosages prescribed were compared with dosages recommended. The proportion of patients with recorded pre-treatment body weight was 64.5% in 2003, which increased to 96.5% in 2007-2010 (p<0.001). The proportion of patients treated with consistent dosing of a 3-drug fixed-dose combination (FDC) increased from 73.9% in 2003 to 87.7% in 2007-2010 (p<0.001), and that for 2-drug FDC from 76.0% to 86.1% (p = 0.024), for rifampicin (RMP) from 62.8% to 85.5% (p<0.001), and for isoniazid from 87.8% to 95.3% (p<0.001). In 2007-2010, among 2917 patients treated with either FDCs or RMP in single-drug preparation, the dosage of RMP was adequate (8-12 mg/kg) in 2571(88.1%) patients, too high in 282(9.7%), too low in 64(2.2%). In multinomial logistic regression models, factors significantly associated with adequate dosage of RMP were body weight and preparations of RMP. Patients weighting <40 kg (relative risk ratio (rrr) 6010.5, 95% CI 781.1-46249.7) and patients weighting 40-49 kg (rrr 1495.3, 95% CI 200.6-11144.6) were more likely to receive higher-than-recommended dose of RMP.
  
  
  CONCLUSIONS
  Prescribing practice in the treatment of TB in Taipei City has remarkably improved after health authorities implemented a series of interventions.
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France.
authors.forename: Chen-Yuan
authors.initials: CY
authors.lastname: Chiang
authors.forename: Ming-Chih
authors.initials: MC
authors.lastname: Yu
authors.forename: Hsiu-Chen
authors.initials: HC
authors.lastname: Shih
authors.forename: Muh-Yong
authors.initials: MY
authors.lastname: Yen
authors.forename: Yu-Ling
authors.initials: YL
authors.lastname: Hsu
authors.forename: Shiang-Lin
authors.initials: SL
authors.lastname: Yang
authors.forename: Tao-Ping
authors.initials: TP
authors.lastname: Lin
authors.forename: Kuan-Jen
authors.initials: KJ
authors.lastname: Bai
mesh_terms: D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D001835:Body Weight; D004305:Dose-Response Relationship, Drug; D004338:Drug Combinations; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007538:Isoniazid / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011718:Pyrazinamide / Q000008:administration & dosage / Q000627:therapeutic use; D012293:Rifampin / Q000008:administration & dosage / Q000627:therapeutic use; D013624:Taiwan; D014376:Tuberculosis / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D004338:Drug Combinations; C087181:isoniazid, pyrazinamide, rifampin drug combination; D011718:Pyrazinamide; D007538:Isoniazid; D012293:Rifampin