title: Liquid vs Solid Culture Medium to Evaluate Proportion and Time to Change in Management of Suspects of Tuberculosis-A Pragmatic Randomized Trial in Secondary and Tertiary Health Care Units in Brazil.
abstract: BACKGROUND
  The use of liquid medium (MGIT960) for tuberculosis (TB) diagnosis was recommended by WHO in 2007. However, there has been no evaluation of its effectiveness on clinically important outcomes.
  
  
  RESULTS
  A pragmatic trial was carried out in a tertiary hospital and a secondary health care unit in Rio de Janeiro City, Brazil. Participants were 16 years or older, suspected of having TB. They were excluded if only cerebral spinal fluid or blood specimens were available for analysis. MGIT960 technique was compared with the Lowenstein-Jensen (LJ) method for laboratory diagnosis of active TB. Primary outcome was the proportion of patients who had their initial medical management changed within 2 months after randomisation. Secondary outcomes were: mean time for changing the procedure, patient satisfaction with the overall treatment and adverse events. Data were analysed by intention-to-treat. Between April 2008 and September 2011, 693 patients were enrolled (348 to MGIT, 345 to LJ). Smear and culture results were positive for 10% and 15.7% of participants, respectively. Patients in the MGIT arm had their initial medical management changed more frequently than those in the LJ group (10.1% MGIT vs 3.8% LJ, RR 2.67 95% CI 1.44-.96, p = 0.002, NNT 16, 95% CI 10-39). Mean time for changing the initial procedure was greater in LJ group at both sites: 20.0 and 29.6 days in MGIT group and 52.2 and 64.3 in LJ group (MD 33.5, 95% CI 30.6-36.4, p = 0.0001). No other important differences were observed.
  
  
  CONCLUSIONS
  This study suggests that opting for the MGIT960 system for TB diagnosis provides a promising case management model for improving the quality of care and control of TB.
  
  
  BACKGROUND
  Controlled-Trials.com ISRCTN79888843.
authors.affiliation: Tuberculosis Academic Program, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Adriana da Silva Rezende
authors.initials: Ada S
authors.lastname: Moreira
authors.affiliation: Tuberculosis Academic Program, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Gisele
authors.initials: G
authors.lastname: Huf
authors.affiliation: Tuberculosis Academic Program, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Maria Armanda Monteiro da Silva
authors.initials: MA
authors.lastname: Vieira
authors.affiliation: Tuberculosis Academic Program, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Policlínica Augusto Amaral Peixoto, Guadalupe/SMS, Rio de Janeiro, Brazil.
authors.forename: Paulo Albuquerque da
authors.initials: PA
authors.lastname: Costa
authors.affiliation: Tuberculosis Academic Program, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Fábio
authors.initials: F
authors.lastname: Aguiar
authors.affiliation: Tuberculosis Academic Program, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Anna Grazia
authors.initials: AG
authors.lastname: Marsico
authors.affiliation: Tuberculosis Academic Program, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Leila de Souza
authors.initials: Lde S
authors.lastname: Fonseca
authors.affiliation: Policlínica Augusto Amaral Peixoto, Guadalupe/SMS, Rio de Janeiro, Brazil.
authors.forename: Mônica
authors.initials: M
authors.lastname: Ricks
authors.affiliation: Tuberculosis Academic Program, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Martha Maria
authors.initials: MM
authors.lastname: Oliveira
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Detjen
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France.
authors.forename: Paula Isono
authors.initials: PI
authors.lastname: Fujiwara
authors.affiliation: Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Stephen Bertel
authors.initials: SB
authors.lastname: Squire
authors.affiliation: Tuberculosis Academic Program, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Afranio Lineu
authors.initials: AL
authors.lastname: Kritski
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D001431:Bacteriological Techniques; D001938:Brazil; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D011933:Reagent Kits, Diagnostic; D063127:Secondary Health Care; D063128:Tertiary Health Care; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D011933:Reagent Kits, Diagnostic