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Correspondence to: Dr P Ormerod.
Received 30 September 1997; Returned to author 9 December 1997; Revised version received 23 December 1997; Accepted for publication 21 January 1998
BACKGROUND
The
guidelines on chemotherapy and management of tuberculosis in the United
Kingdom have been reviewed and updated.
METHODSA
subcommittee was appointed by the Joint Tuberculosis Committee (JTC) of
the British Thoracic Society to revise the guidelines published in 1990 by the JTC. In preparing the revised guidelines the authors took
account of new published evidence and graded the strength of evidence
for their recommendations. The guidelines have been approved by the JTC
and the Standards of Care Committee of the British Thoracic Society.
RECOMMENDATIONS(1)
Patients with tuberculosis should be notified. (2) In view of the
rising incidence of drug resistance, bacteriological confirmation and
drug susceptibility testing should be sought whenever possible. (3) A
six month short course regimen, with four drugs in the initial phase,
should be used for all forms of tuberculosis, except meningitis, in
both adults and children. (4) The fourth drug (ethambutol) in the
initial phase can be omitted in certain circumstances. (5) Treatment of
all patients should be supervised by physicians with full training in
the management of tuberculosis and with direct working access to
tuberculosis nurse specialists or health visitors. (6) Advice is given
on (a) management in special situations and patient groups, (b) drug interactions, and special precautions and pretreatment screening, (c)
chemoprophylaxis for different groups, and (d) the management of single
and multiple drug resistance. (7) Advice is given on follow up after
treatment and the organisational framework for tuberculosis services.
(8) The role of directly observed therapy is discussed. (9) The
management of multidrug resistant tuberculosis is explained in outline:
such patients should be managed by physicians with special experience
and in close liaison with the Mycobacterium Reference Units, and in
hospitals with appropriate isolation facilities. (10) Infection control
and segregation for such patients and for patients with dual infection
with human immunodeficiency virus (HIV) and tuberculosis are covered in
an appendix.
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