Management of TB cases falls short of international standards

The research, published online ahead of print in the European Respiratory Journal, has identified key areas of priority for public action to combat the growing number of drug-resistant tuberculosis cases.

The World Health Organization (WHO) estimates a prevalence of 440,000 multidrug-resistant TB cases (MDR-TB) with 150,000 deaths and 50,000 extremely drug-resistant tuberculosis (XDR-TB) cases. The emergence of resistant forms of tuberculosis can in part be attributed to the mismanagement of the disease.

To help understand how these forms of the disease have emerged, the authors aimed to evaluate the extent of inappropriate TB case management in Europe. To achieve this they conducted a survey, funded by the European Centre for Disease Prevention and Control (ECDC). The survey included questions devised by an expert panel and compared the answers to a number of internationally recognised guidelines on prevention, diagnosis and treatment of the disease.

The study used data on 200 TB cases from five TB reference institutes in five EU countries. The findings revealed that standards are not being adequately met in both the treatment and monitoring of patients.

10% of patients were prescribed less than the four drugs which are recommended and were therefore not sufficiently treated. Furthermore, various errors were identified in the doses of anti-TB drugs which were prescribed. The results also highlighted that patients infected with HIV alongside TB were not satisfactorily managed in almost 34% of cases.

For the monitoring of patients, there was a lack of information on the health of discharged patients with no final outcomes recorded for 32% of patients.

Dr G.B. Migliori, one of the lead authors of the study, said: "MDR-TB is a man-made product and every error in treating a case of MDR-TB can be seen as potential for generating a new MDR-TB case. The results of this study have identified a number of mistakes and deviations from the recommended practices in the management of TB and MDR-TB/XDR-TB cases in Europe. To help prevent the further emergence of drug-resistant TB, we must increase awareness and training, promote standards of care and allocate appropriate resources where necessary."

Provided by European Lung Foundation