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PubMed1998

Chemotherapy and management of tuberculosis in the United Kingdom: recommendations 1998. Joint Tuberculosis Committee of the British Thoracic Society.

BACKGROUND: The guidelines on chemotherapy and management of tuberculosis in the United Kingdom have been reviewed and updated. METHODS: A 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.

Adult↗
PubMed1990

Control and prevention of tuberculosis in Britain: an updated code of practice. Subcommittee of the Joint Tuberculosis Committee of the British Thoracic Society.

A subcommitte was appointed by the Joint Tuberculosis Committee of the British Thoracic Society to review and bring up to date guidelines on control measures for tuberculosis. The updated code of practice emphasises that all cases of tuberculosis must be notified. A minority of patients need admission, and those with positive sputum smears should be regarded as infectious until they have received two weeks of chemotherapy. NHS staff at risk should be protected, and evidence of infectious tuberculosis should be sought as routine among certain prospective NHS employees, schoolteachers, and others. Contact tracing should be vigorously pursued, and all entrants to Britain from countries where tuberculosis is common should be screened. BCG vaccination should be offered in selected instances, and local organisation of tuberculosis services should be extended.

Algorithms↗
PubMed1989

[Situation of tuberculosis in the world and the role expected of Japan in the global fight against tuberculosis].

The whole world is divided into 3 groups by the magnitude of tuberculosis problem: namely, developed countries in which tuberculosis is already a minor health problem and continues to decline; NIES and some oil-producing countries in which tuberculosis started to decline significantly; and most developing countries in which tuberculosis is still highly prevalent and no or only a slow decline. Number of new smear positive pulmonary tuberculosis in the whole world in a year is estimated at about 4.5 million, and adding smear negative pulmonary tuberculosis and extra-pulmonary tuberculosis, total number of new tuberculosis patients amounts to 9 to 10 million, and nearly 3 million persons die every year from tuberculosis, and 97% of these cases occur in developing countries. Failure of tuberculosis control in most developing countries could be explained by slow economic development of financial crisis, which caused poor allocation of budget for health including tuberculosis programme and slow development of primary health care. Activities of tuberculosis supervisory teams are weak. Tuberculosis programmes succeeded in developed countries could not be implemented easily in developing countries. New obstacles to the rapid decline of tuberculosis are the epidemic of AIDS, movement of population and lowering concern on tuberculosis problems, and tuberculosis will remain as one of serious global health problems at least for coming several decades. Maintenance of research and training facilities for tuberculosis is needed, however, they have been disappearing in developed countries. Facilities in developing countries might have difficulties to maintain unless financial and technical support is given from developed countries. Japan is the second biggest economic power in the world, and it is our duty to increase ODA for developing countries. In the field of health, Dr. Nakajima started to work as the director-general of WHO since 1988. We have to intensify our technical cooperation in health. As we succeeded to control tuberculosis in the past 40 years and still maintain research and training facilities for tuberculosis, they should be used for the sake of developing countries. Multi-and bi-lateral cooperation in tuberculosis control should also be intensified. The author would like to urge members of the Japanese Society for Tuberculosis to talk about the importance of tuberculosis problem and role expected to Japan in the global fight against tuberculosis to people outside the society so as to have appropriate understanding on global tuberculosis problems.

Developing Countries↗
PubMed2001

[Two-step tuberculin skin test in general hospital workers--comparison with nursing home workers].

In 1998, the Japanese Society for Tuberculosis recommended two-step tuberculin skin test (TST) for medical workers. As a large majority of the Japanese were BCG vaccinated in their childhood, it is difficult to distinguish true infection from booster effect. In Japan, it is important to record individual baseline tuberculin reactivity by two-step TST. Two-step TST was performed on 126 general hospital workers and 47 nursing home workers, excluding those whose initial TST was strongly positive, according to the recommendation of the Japanese Society for Tuberculosis in 1998 (strongly positive TST in Japan is defined as the reaction with other intensive responses such as double skin erythema, bleb, lymphangitis, etc.). Diameter of erythema of TST among hospital workers v.s. nursing home workers were as follows. In the initial TST: 23.2 +/- 16.7 mm v.s. 14.2 +/- 10.3 mm (p < 0.001), in the second TST: 26.3 +/- 17.1 mm v.s. 16.7 +/- 9.9 mm (p < 0.02), baseline of TST: 32.0 +/- 18.3 mm v.s. 19.4 +/- 10.7 mm (p < 0.001). Booster effect of TST in hospital workers was +9.8 +/- 15.1 mm, while it was +4.8 +/- 7.8 mm (not significant) in nursing home workers. Among those 30 years and over, these differences were no found, except diameter of erythema in the initial TST. In our hospital with no beds for TB, in the past 10 years, tuberculosis has not been broken out among our hospital workers, while several patients with pulmonary tuberculosis have been diagnosed every year (6 patients in 1999). Thus, some hospital workers might be exposed to infection with tuberculosis from these patients. On the other hands, no tuberculosis patients had been diagnosed in the nursing home, and young nursing home workers very rarely exposed to infection with tuberculosis in their life, and they are similar to the general population. This study suggested that hospital workers were more frequently exposed to tuberculosis infection than other workers.

Adult↗
PubMed2002

[A 50-year year history of new drugs in Japan: the developments of antituberculosis drugs and their influences on the epidemiological aspects].

Drugs used in the treatment of tuberculosis (Tb) in Japan are investigated. Especially the chemotherapy for Tb and its influences on epidemiological aspects are discussed. 1. Various drugs were used for Tb patients before the World War II, but none was effective in curing this infectious disease. Creosote and guajacol groups were used frequently to relieve symptoms of pulmonary tuberculosis, but the disease could not cure itself. Because of the sacrifice of young patients, the mortality rate of Tb from 1935 to 1950 was ranked as the worst in Japan. So until the advent of chemotherapeutic drugs, Tb was known as the most formidable fatal plague. 2. Streptomycin (SM), the first effective chemotherapeutic drug, was imported into Japan and widely used from 1947. PAS in 1950 and isoniazid (INH) in 1952 were introduced to Tb therapy. The triple combination therapy of these drugs was considered the most favorable regimen for Tb from the 1950s to the early 1970s. Excellent results were obtained in this period. The mortality rate of Tb had dropped rapidly from its peak to half in 1952 and to a fourth in 1956 (Figs. 2, 3). 3. Several anti-Tb drugs, such as pyrazinamide ethionacide, ethambutol, and some antibiotics (kanamycin, cyloserine, and capreomycin) had been discovered and used in practice. These were not used singly, because of their weak clinical efficacies and severe side effects. They were mostly used to prevent the development of bacillus resistance to SM or INH. In the guidelines of the Japanese Society for Tuberculosis, in 1974. drugs used for Tb could be divided into two major categories: first-line and second-line groups. The second-line drugs included those that prevent a high resistance to the main (first-line) drugs. 4. Rifampicin (RFP), the most valuable drug for Tb, was introduced in therapy in Japan in 1971. RFP has a low incidence of severe side-effects, but because of the rapidity with which resistance may develop, it cannot be used alone. RFP in combination with INH is the most effective therapy for all forms of the disease. The guidelines, newly proposed in 1986 by the Japanese Society for Tuberculosis recommended the short 6-month course of treatment that used combination of RFP and INH. The advent of RFP had contributed to the cure of the individual patient, but it did not effect the mortality or the morbidity rate of Tb. Chemotherapy is the most effective means of suppressing tuberculosis, which was formerly nearly always fatal, but it could not completely eradicate the disease. Preventing the development of resistance to chemotherapeutic drugs might be a special problem.

History, 20th Century↗