Survey of the initial treatment of pulmonary tuberculosis in West Germany. A study by the German Central Committee for the Prevention of Tuberculosis
Zierski, M.; Hoffmann, O.; Bornhardt, E.
Pneumologie 43(12): 691-702
1989
ISSN/ISBN: 0934-8387 PMID: 2622876 Document Number: 343663
1405 adult patients were selected for assessment who had been newly notified in the years 1986/87 with confirmed diagnosis of active progressive pulmonary tuberculosis who required treatment. Of these, 83.5% excreted tubercle bacilli in the sputum; radiographic lung cavities were confirmed in 53.6%, and 859 (61.1%) had a concomitant disease. 1173 patients (94.2%) were hospitalized for initial treatment and only 232 (5.8%) received outpatient treatment. The median duration of the hospital stay was 12 weeks. Isoniazid and rifampicin were prescribed in 96% and 93% patients, respectively, mostly all the time, ethambutol in 75% initially and in 50% throughout, streptomycin in 50% initially. Three or four drug regimens including pyrazinamide in the initial phase were employed in 76% of the patients. Premature discontinuation of therapy for different reasons was noted in 135 patients (9.5%). Of these, treatment was discontinued in 59 (4.2%) due to death; 37 (2.6%) patients died due to tuberculosis. Adverse reactions were observed in 193 patients (13.7%); 0.3% of the patients discontinued chemotherapy because of toxicity. The duration of chemotherapy was between 9 and 12 months in the majority of patients; 30%, however, were treated for more than 12 months. The chemotherapy of 6-months duration was performed only in about 10% of treated patients. Among the patients who completed the treatment, this proved effective in 98%. Although the majority received initially the rational chemotherapy with a three or four drugs regimen, it is concluded that the inpatient stay and the outpatient duration of chemotherapy in the routine clinical practice is too long, therapy control is insufficient.