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Think TB! Is the diagnosis of pulmonary tuberculosis delayed by the use of antibiotics?

Craig, SE; Bettinson, H; Sabin, CA; Gillespie, SH; Lipman, MCI; (2009) Think TB! Is the diagnosis of pulmonary tuberculosis delayed by the use of antibiotics? INT J TUBERC LUNG D , 13 (2) 208 - 213.

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Abstract

SETTING: Effective tuberculosis (TB) control requires prompt diagnosis of infectious cases through early suspicion of pulmonary TB in all subjects with suspected respiratory infection.OBJECTIVE: To test our hypothesis that prior antibiotic treatment for presumed bacterial infection leads to a delay in diagnosing TB in a European country with low TB incidence.DESIGN: Adults with culture-confirmed pulmonary TB at a single metropolitan centre were assessed for the impact of any previous antibiotic treatment on symptoms and the time to starting specific anti-tuberculosis treatment.RESULTS: Of 83 patients, 42 (51%) received antibiotics prior to TB diagnosis, with symptomatic improvement reported in 20 of the 42 (48%) patients. This was unrelated to specific drug class. Although the median time to diagnosis in subjects receiving antibiotics was prolonged (P = 0.001), this was not predicted by treatment response. In 94% of cases, the initial chest radiograph was suggestive of TB infection.CONCLUSION: Patients receiving antibiotics prior to TB confirmation experience a process-related delay in starting treatment. To minimise the risk of ongoing TB transmission, we propose that clinicians should include TB in their differential diagnosis and initiate simple, TB-focused investigations early on in the diagnostic process.

Type: Article
Title: Think TB! Is the diagnosis of pulmonary tuberculosis delayed by the use of antibiotics?
Keywords: pulmonary tuberculosis, antibiotics, delayed diagnosis, CARE-SYSTEM DELAYS, MYCOBACTERIUM-TUBERCULOSIS, PATIENT, FLUOROQUINOLONES, CLARITHROMYCIN, ENGLAND, WALES
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Respiratory Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health > Infection and Population Health
URI: http://discovery.ucl.ac.uk/id/eprint/176724
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