Background: Incomplete or incorrect antibiotic therapy,
especially in the initial phase of antituberculosis (anti-TB)
treatment, is a major cause of acquired drug resistance and treatment
failure. We determined the extent of errors in anti-TB treatment
regimens by way of nonadherence to recommended treatment protocols
among patients with TB in Baltimore, MD, a city with declining rates of
disease. An error was defined as using too few drugs or the wrong
drugs, giving inadequate doses of drugs, or prescribing an inadequate
duration of treatment.
Methods: We reviewed the
records of all patients with culture-positive, pulmonary TB reported in
the city of Baltimore from January 1, 1994, to December 31, 1995. We
determined demographic information, initial anti-TB regimen, doses and
duration of therapy, history or presence of resistance to anti-TB
drugs, injecting-drug or alcohol abuse, HIV status, and whether
treatment was given by a private physician or by the Tuberculosis
Clinic of the Baltimore City Health Department (BCHD).
Results: Of the 110 cases of active pulmonary TB, 17 cases
(15.4%) had errors in treatment for control of their current disease.
Thirteen of 34 privately treated patients (38%) had some error in
their initial anti-TB regimen, compared with 4 of 76 patients (5.2%)
treated by the Tuberculosis Clinic of the BCHD (p < 0.0001).
Patients were otherwise similar as determined by age, sex, HIV status,
drug-resistance characteristics, and injecting-drug use, regardless of
whether they had erroneous anti-TB regimens.
Conclusion: In a low-prevalence area, private physicians
make frequent errors in prescribing anti-TB therapy. Additional
educational resources for physicians and increased use of expert
consultation may contribute to improved TB control.