SHORT-COURSE THERAPY OF PULMONARY TUBERCULOSIS - DOCTORS COMPLIANCE

Objective: The present study, conducted from 1986 to 1991, investigate d the accuracy of treatment monitoring performed by practitioners in t he out-patient treatment of pulmonary tuberculosis. Design: All patien ts with smear or culture positive pulmonary tuberculosis, receiving 6- month short-course chemotherapy with Isoniazid (H), Rifampicin (R) and Pyrazinamide (Z), were included. Treatment had been initiated either in our unit, or shortly before, with discharge after an average time o f 8 weeks. Practitioners were sent a flow sheet advising how to perfor m standardized ambulatory controls. Results: Forty-three patients were included in the study, four of whom did not visit their practitioner after discharge. It must be assumed that they did not complete treatme nt. The average follow-up time of the remaining 39 patients was 159 we eks. In 13 cases the treatment was prolonged without obvious reason. F or four patients who had not converted to a negative sputum culture at discharge, negativity was never been proven thereafter. Objective mea ns of assessing patient compliance by H-urine strip testing were under taken only in three cases. X-ray controls were performed adequately in 44.4% of the cases. By contrast monthly checks of liver enzymes had b een done only in 23.1% of the patients. Conclusion: We conclude that e ven a highly standardized protocol of short-course tuberculosis treatm ent requires a certain level of experience and compliance on the part of the practitioner. We accordingly recommend that every case of pulmo nary tuberculosis should be reviewed at least twice by a chest physici an.