Errors in the treatment of tuberculosis in Baltimore

Background: Incomplete or incorrect antibiotic therapy, especially in the i nitial phase of antituberculosis (anti-TB) treatment, is a major cause of a cquired 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 de clining rates of disease. An error was defined as using too few drugs or th e wrong drugs, giving inadequate doses of drugs, or prescribing an inadequa te duration of treatment. Methods: We reviewed the records of all patients with culture-positive, pul monary TB reported in the city of Baltimore from January 1, 1994, to Decemb er 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 treatmen t was given by a private physician or by the Tuberculosis Clinic of the Bal timore City Health Department (BCHD). Results: Of the 110 cases of active pulmonary TB, 17 cases (15.4%) had erro rs in treatment for control of their current disease. Thirteen of 34 privat ely 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 o f the BCHD (p < 0.0001). Patients were otherwise similar as determined by a ge, sex, HIV status, drug-resistance characteristics, and injecting-drug us e, regardless of whether they had erroneous anti-TB regimens. Conclusion: In a low-prevalence area, private physicians make frequent erro rs in prescribing anti-TB therapy. Additional educational resources for phy sicians and increased use of expert consultation may contribute to improved TB control.