Impact of empiric antibiotics and chest radiograph on delays in the diagnosis of tuberculosis

Jonathan E. Golub, S. Bur, W. A. Cronin, S. Gange, T. R. Sterling, B. Oden, N. Baruch, G. W. Comstock, R. E. Chaisson

Research output: Contribution to journalArticle

Abstract

SETTING: Maryland Department of Health and Mental Hygiene, Division of Tuberculosis (TB) Control. OBJECTIVES: To assess the implications of antibiotic treatment of presumed community-acquired pneumonia (CAP) on delays in the diagnosis of TB, and to assess the frequency with which chest radiographs (CXRs) were utilized before a diagnosis of pneumonia or pulmonary TB was made. DESIGN: A nested case-control study within a prospective study conducted to assess factors associated with delays in the diagnosis of TB. RESULTS: Cases (n = 85; 54%) were patients who received antibiotics for non-TB diagnoses/indications prior to TB diagnosis, and controls (n = 73; 46%) were patients who had initially received TB therapy. Median health care delay for cases was 39 days vs. 15 days (P < 0.01) for controls. Median antibiotic delay was similar among all antibiotic classes. Of 54 patients who did not have a CXR at their first health care visit, 41 (79%) received empiric antibiotics, compared to 44/105 (42%) who had a CXR (P < 0.01). Only 31/54 (57%) patients initially diagnosed with CAP had a CXR at the time of diagnosis. CONCLUSION: More widespread use of CXR when diagnosing CAP should reduce delays in diagnosing TB, and the unnecessary use of antibiotics.

Original languageEnglish (US)
Pages (from-to)392-397
Number of pages6
JournalInternational Journal of Tuberculosis and Lung Disease
Volume9
Issue number4
StatePublished - Apr 1 2005

Keywords

  • Antibiotics
  • Community-acquired pneumonia
  • Delayed diagnosis
  • Tuberculosis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases

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