       Document 0327
 DOCN  M9460327
 TI    Essentials of tuberculosis control for the practising physician.
       Tuberculosis Committee, Canadian Thoracic Society.
 DT    9408
 SO    Can Med Assoc J. 1994 May 15;150(10):1561-71. Unique Identifier :
       AIDSLINE MED/94228398
 AB    OBJECTIVE: To recommend guidelines for the management of tuberculosis
       (TB), particularly in high-risk groups including poor and homeless
       people, aboriginal Canadians, immigrants from countries where TB is
       highly prevalent and people with HIV infection. OPTIONS: Diagnosis,
       pharmacotherapy, vaccination and chemoprophylaxis. OUTCOMES: Prevention
       of infection and diagnosis and cure of TB. EVIDENCE: The evidence was
       gathered in late 1992 from previous guidelines, recommendations by
       specialist societies and new studies. VALUES: Evidence was categorized
       into four levels: I, randomized clinical trials of therapeutic
       interventions or prospective studies of diagnostic strategies; II,
       case-control studies; III, retrospective descriptive studies; and IV,
       consensus of the committee members and published statements. The
       Tuberculosis Committee of the Canadian Thoracic Society comprises
       experts in TB from across Canada. BENEFITS, HARM AND COSTS: The benefits
       of early diagnosis and prompt initiation of therapy are well documented.
       The cost effectiveness of antituberculous therapy in developing
       countries is well documented. In developed countries chemoprophylaxis
       has been shown to be cost effective, and directly observed chemotherapy
       has recently been hypothesized to have economic benefits.
       RECOMMENDATIONS: In the appropriate clinical setting, particularly when
       patients are known to be at high risk of TB, clinicians should consider
       TB, reserve body secretions for mycobacteriologic tests and conduct
       other investigations such as chest radiography. Furthermore, if TB is
       strongly suspected or confirmed by appropriate investigation the early
       initiation of multi-drug therapy, including at least three first-line
       drugs, is strongly recommended. If drug resistance is suspected a
       regimen of four to five drugs, including at least two drugs with which
       the patient has not been treated, should be started. If the strain is
       found to be resistant to any of the drugs in the regimen appropriate
       changes should be made. Chemoprophylaxis should be considered especially
       in contacts with a recent significant reaction to the purified protein
       derivative (PPD) skin test and in people known to be at risk of
       reactivated TB infection, particularly those with HIV infection and a
       significant PPD skin-test result. Vaccination with bacillus
       Calmette-Guerin should be limited to high-risk groups, particularly
       aboriginal Canadians living on reserves. VALIDATION: These
       recommendations are based on a consensus of Canadian experts supported
       by other specialist societies and reference groups. They have been
       reviewed by the Standards Committee of the Canadian Thoracic Society.
       SPONSOR: The Canadian Lung Association and the Tuberculosis Committee of
       the Canadian Thoracic Society.
 DE    Algorithms  Antitubercular Agents/ADVERSE EFFECTS/THERAPEUTIC USE  BCG
       Vaccine  Human  Risk Factors  Tuberculin Test
       Tuberculosis/*DIAGNOSIS/*DRUG THERAPY/PREVENTION & CONTROL  GUIDELINE
       JOURNAL ARTICLE  PRACTICE GUIDELINE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

