title: Spanish Compliance With Guidelines for Prescribing Four Drugs in the Intensive Phase of Standard Tuberculosis Treatment.
abstract: BACKGROUND
  International and Spanish guidelines recommend a 4-drug regimen in the intensive treatment of tuberculosis (TB). The aim of our study was to determine if these recommendations are followed in Spain, and the factors associated with the use of 3 drugs (standard regimen without ethambutol).
  
  
  METHODS
  Observational, multicenter, retrospective analysis of data from patients diagnosed with TB in practically all Spanish Autonomous Communities between 2007 and 2102. Factors associated with the use of 3 drugs were analyzed using logistic regression, and odds ratios (OR) and corresponding 95% confidence intervals (CI) were calculated.
  
  
  RESULTS
  A total of 3,189 patients were included, 1,413 (44.3%) of whom received 3 drugs. The percentage of 3-drug users among patients with positive sputum smear was 41.2%; among patients with resistance to at least 1 drug, 36.1%; among HIV-infected patients, 31.4%; and among immigrants, 24.8%. Factors associated with the use of 3 drugs were: female sex (OR=1.18; CI: 1.00-1.39); native Spanish (OR=3.09; CI: 2.58-3.70); retired (OR=1.42; CI: 1.14-1.77); homeless (OR=3.10; CI: 1.52-6.43); living alone (OR=1.62; CI: 1.11-2.36); living in a family (OR=1.97; CI: 1.48-2.65); seen by specialists in the region (OR=1.37; CI: 1.10;1.70); no HIV infection (OR=1.63; CI: 1.09-2.48); and negative sputum smear with positive culture (OR=1.59; CI: 1.25-2.02).
  
  
  CONCLUSIONS
  A large proportion of TB patients receive intensive treatment with 3 drugs. TB treatment recommendations should be followed, both in routine clinical practice and by the National Plan for Prevention and Control of Tuberculosis in Spain.
authors.affiliation: UGC Neumología, Hospital San Agustín, Avilés, Asturias, España; Programa Integrado de Investigación en Tuberculosis (PIITB) de SEPAR, España. Electronic address: josemaria.garciag@sespa.es.
authors.forename: José-María
authors.initials: JM
authors.lastname: García-García
authors.affiliation: Fundación Respira, Sociedad Española de Neumología y Cirugía Torácica (SEPAR), España; Programa Integrado de Investigación en Tuberculosis (PIITB) de SEPAR, España.
authors.forename: Teresa
authors.initials: T
authors.lastname: Rodrigo
authors.affiliation: Agencia de Salud Pública de Barcelona, Barcelona, España; Programa Integrado de Investigación en Tuberculosis (PIITB) de SEPAR, España.
authors.forename: Martí
authors.initials: M
authors.lastname: Casals
authors.affiliation: Servicio de Neumología, Hospital Germans Trias i Pujol, Badalona, Barcelona, España; Programa Integrado de Investigación en Tuberculosis (PIITB) de SEPAR, España.
authors.forename: Juan
authors.initials: J
authors.lastname: Ruiz-Manzano
authors.affiliation: Servicio de Neumología, Hospital de Cabueñes, Gijón, Asturias, España; Programa Integrado de Investigación en Tuberculosis (PIITB) de SEPAR, España.
authors.forename: Teresa
authors.initials: T
authors.lastname: Pascual-Pascual
authors.affiliation: Agencia de Salud Pública de Barcelona, Barcelona, España; Programa Integrado de Investigación en Tuberculosis (PIITB) de SEPAR, España.
authors.forename: Joan A
authors.initials: JA
authors.lastname: Caylà
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use*; D015897:Comorbidity; D011307:Drug Prescriptions / Q000592:standards* / Q000706:statistics & numerical data; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data; D008297:Male; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D017678:Sex Distribution; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology; D013183:Sputum / Q000382:microbiology; D014376:Tuberculosis / Q000188:drug therapy* / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D000995:Antitubercular Agents
keywords: Adherence; Adherencia; Guidelines; Normativas; Tratamiento; Treatment; Tuberculosis