INITIAL-DRUG REGIMENS FOR THE TREATMENT OF TUBERCULOSIS - EVALUATION OF PHYSICIAN PRESCRIBING PRACTICES IN NEW-JERSEY, 1994 TO 1995

Study objective: To evaluate physician prescribing practices for the i nitial therapy for tuberculosis (TB) according to the recommendations of the Centers for Disease Control and Prevention (CDC) and American T horacic Society (ATS). Design: Cross-sectional study. Setting: Statewi de TB surveillance system in New Jersey, 1994 to 1995. Patients: We st udied 1,230 culture-positive TB patients who were alive at diagnosis a nd whose isolates were tested for isoniazid susceptibility. Results: A lmost all TB patients (98%) were reported from counties with an isonia zid-resistant proportion of 4% or more, which is the minimum level for implementation of an initial four-drug regimen recommended by CDC/ATS . Overall, 36% of the 1,230 patients were not initially treated with f our or more drugs. Multivariate analyses found that non-Hispanic white patients were more likely to be treated with fewer than four drugs th an were non-Hispanic black patients. Private practitioners and physici ans at chest clinics were about five times more likely to prescribe fe wer than four drugs initially than were physicians at the hospital whe re a national TB center is located. Conclusion: A substantial proporti on of physicians did not initially treat their TB patients according t o the CDC/ATS recommendations. The results suggest that New Jersey phy sicians should be better informed about the recommendation and the hig h level of drug resistance in the communities they serve to assure tha t TB patients receive appropriate initial therapy.