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Decision for Treatment for Pulmonary Tuberculosis of Acid-Fast Bacilli Smear Negative Cases: The Tuberculosis Diagnostic Committee (TBDC) Experience in District IV of Manila, Philippines From 2007-2010 FREE TO VIEW

Julie Christie Visperas, MD; Jose Hesron Morfe, MD
Chest. 2011;140(4_MeetingAbstracts):948A. doi:10.1378/chest.1115447
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PURPOSE: The TBDC is a committee that is responsible for evaluating cases of TB symptomatics who are smear (-), but whose chest radiographs show lesions suggestive of tuberculosis. It was set up originally by the Department of Health, National TB Program (NTP) with the advise of WHO-Western Pacific Regional Office. In the District IV of Manila, it has started since January 2007 with the meetings being held at least every 2 weeks at the University of Santo Tomas Hospital. This study aimed to describe the TBDC experience of District IV of Manila, Philippines (high burden country for tuberculosis).

METHODS: All cases seen by TBDC District IV from January 2007 to December 2010 were included in the study. The summary of report for each meeting was tabulated and descriptive statistics was done using SPSS version 14.

RESULTS: A total of 1,505 cases were referred to TBDC District IV in the study period. In 2007, 43.12% (116 out of 269) were decided upon by the TBDC as inactive and therefore not warranting treatment; while in 2008, a higher rate of 58.85% (226 out of 384) did not warrant treatment. In 2009, 44.24% (192 out of 434) was decided to be inactive for tuberculosis and did not to receive treatment, while 47.85% (200 out of 418) in the year 2010. Over the period of 2007-2010, a total of 771 of the 1,505 cases (51.23%) referred to the committee was recommended for treatment while 48.77% (734 out of 1,505) was decided by the committee as either inactive or those not warranting treatment.

CONCLUSIONS: The TBDC of District IV was able to recommend 51.23% of smear negative patients for treatment while spared the 48.77% of cases referred to them from 2007-2010. This may imply that the TB diagnostic Committee of District IV had almost equal percentage of recommendation and denunciation for anti-TB treatment.

CLINICAL IMPLICATIONS: In a high burden country for pulmonary tuberculosis, like the Philippines, empiric anti-TB treatment on patients with negative sputum AFB poses a significant problem. The TBDC is an avenue by which careful evaluation of cases are done to recommend anti TB treatment or against treatment which in effect would prevent over-treatment for PTB.

DISCLOSURE: The following authors have nothing to disclose: Julie Christie Visperas, Jose Hesron Morfe

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