MANAGEMENT OF TUBERCULOSIS IN WALES - 1986-92

Objectives-To describe the epidemiology of childhood tuberculosis in W ales and to assess the standard of management of patients with tubercu losis. Design-Retrospective study of data retrieved from case notes an d review of radiographs of all identified patients. Subjects-Forty eig ht cases of tuberculosis and 10 of tuberculosis chemoprophylaxis in ch ildren under 15 years of age, in Wales, between January 1986 and Decem ber 1992. Main outcome measures-Management of childhood tuberculosis i n Wales compared with the published recommendations of the Joint Tuber culosis Committee of the British Thoracic Society. Results-Documentati on was poor in most of the 48 cases of tuberculosis and only 31 (65%) were formally notified. One third of patients were asymptomatic and we re detected by contact tracing; only eight (17%) were culture positive . Only 20% of patients from ethnic minorities had previously been immu nised with BCG. Management and chemotherapy varied widely. Few patient s were managed jointly by paediatricians and chest doctors. Only 10% c ompleted treatment with a recommended chemotherapy regimen. In 37% of patients treatment was inadequate, and in the remainder either the cho ice of drugs or the duration of treatment was inappropriate. No patien t died, nor had any relapsed by June 1995. Conclusions-Very few cases of childhood tuberculosis were managed according to the recommendation s of the British Thoracic Society.