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Diagnosis and Treatment of Childhood Pulmonary Tuberculosis: A Cross-Sectional Study of Practices among Paediatricians in Private Sector, Mumbai.

Tauro CK, Gawde NC - Interdiscip Perspect Infect Dis (2015)

Bottom Line: Sputum negative TB suspect is always tested with X-ray or tuberculin skin test. 61.4% prescribe regimen as recommended in ISTC and all monitor progress to treatment clinically.Drug-resistance at beginning of treatment is suspected for child in contact with a drug-resistant patient (67.7%) and with prior history of antitubercular treatment (12.9%).About half of them (48%) request drug-resistance test for rifampicin in case of nonresponse after two to three months of therapy and regimen prescribed by 41.7% for multidrug-resistant TB was as per ISTC.

View Article: PubMed Central - PubMed

Affiliation: School of Health Systems Studies, Tata Institute of Social Sciences, Sion-Trombay Road, Deonar, Mumbai, Maharashtra 400 088, India.

ABSTRACT
Majority of children with tuberculosis are treated in private sector in India with no available data on management practices. The study assessed diagnostic and treatment practices related to childhood pulmonary tuberculosis among paediatricians in Mumbai's private sector in comparison with International Standards for Tuberculosis Care (ISTC) 2009. In this cross-sectional study, 64 paediatricians from private sector filled self-administered questionnaires. Cough was reported as a symptom of childhood TB by 77.8% of respondents. 38.1% request sputum smear or culture for diagnosis and fewer (32.8%) use it for patients positive on chest radiographs and 32.8% induce sputum for those unable to produce it. Sputum negative TB suspect is always tested with X-ray or tuberculin skin test. 61.4% prescribe regimen as recommended in ISTC and all monitor progress to treatment clinically. Drug-resistance at beginning of treatment is suspected for child in contact with a drug-resistant patient (67.7%) and with prior history of antitubercular treatment (12.9%). About half of them (48%) request drug-resistance test for rifampicin in case of nonresponse after two to three months of therapy and regimen prescribed by 41.7% for multidrug-resistant TB was as per ISTC. The study highlights inappropriate diagnostic and treatment practices for managing childhood pulmonary TB among paediatricians in private sector.

No MeSH data available.


Related in: MedlinePlus

Actions taken by paediatricians when a patient does not respond to treatment. ∗one paediatrician reported that he never came across a patient who did not respond to treatment; figures in parenthesis are number of paediatricians following that practice, MDR (multidrug-resistant) TB; $two of these seven paediatricians did not specify regimen.
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Related In: Results  -  Collection


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fig1: Actions taken by paediatricians when a patient does not respond to treatment. ∗one paediatrician reported that he never came across a patient who did not respond to treatment; figures in parenthesis are number of paediatricians following that practice, MDR (multidrug-resistant) TB; $two of these seven paediatricians did not specify regimen.

Mentions: If the patient was not improving clinically, paediatricians suspected that treatment is failing. Time at which nonresponse to treatment was suspected varied from practitioner to practitioner and was as less as one month to as long as 8 months but most (45 out of 50; 90%) were suspecting it early (within three months of therapy) (Table 6). Most common actions reported by 58 paediatricians included advising sputum culture and drug sensitivity test (35; 60.3%), suspecting and investigating for HIV infection (26; 44.8%), and prescribing another regimen (23; 39.7%). Since practices related to HIV-TB coinfection are not part of the paper, we have presented actions taken by paediatricians for HIV negative nonresponders in Figure 1. One paediatrician mentioned not coming across a nonresponder in practice. Out of the other remaining 63, four (6.3%) did not answer the question and 36 (57.1%) said that they investigate for MDR, whereas 23 (36.5%) mentioned that they prescribe another regimen (details of these regimens are provided subsequently). A total of 50 paediatricians answered question regarding time of suspecting drug-resistant TB, out of which 23 (46%) suspected only after trying second regimen (Table 6). Remaining 27 (54%) reported suspecting drug-resistance during first regimen itself, if sputum was positive at end of first (3; 11.1%), second (17; 63.0%), or third month (7; 25.9%) of therapy, respectively. Thus, 24 (48%) were suspecting drug-resistance at appropriate time (2 to 3 months), all of whom were testing for rifampicin resistance. A total of 31 paediatricians listed conditions when they suspected drug-resistance at beginning of treatment, two-thirds of them listed contact with case of drug-resistant TB, one-third investigated for resistance among HIV positive children, and only four (12.9%) reported suspecting resistance in cases treated with antitubercular drugs in the past. Almost all (48; 94.1%) paediatricians reported that basis of diagnosis of drug-resistance was bacteriological (Table 6). 33 of these who specified the type of test conducted reported use of sputum culture and drug sensitivity (reported by 10) or Xpert MTB/RIF (8) or both (15). Of the 35 who mentioned name of testing laboratories, 27 (77.1%) named laboratories that were accredited by national programme for drug-resistance testing whereas 8 (22.9%) were sending patients to nonaccredited laboratories.


Diagnosis and Treatment of Childhood Pulmonary Tuberculosis: A Cross-Sectional Study of Practices among Paediatricians in Private Sector, Mumbai.

Tauro CK, Gawde NC - Interdiscip Perspect Infect Dis (2015)

Actions taken by paediatricians when a patient does not respond to treatment. ∗one paediatrician reported that he never came across a patient who did not respond to treatment; figures in parenthesis are number of paediatricians following that practice, MDR (multidrug-resistant) TB; $two of these seven paediatricians did not specify regimen.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4563113&req=5

fig1: Actions taken by paediatricians when a patient does not respond to treatment. ∗one paediatrician reported that he never came across a patient who did not respond to treatment; figures in parenthesis are number of paediatricians following that practice, MDR (multidrug-resistant) TB; $two of these seven paediatricians did not specify regimen.
Mentions: If the patient was not improving clinically, paediatricians suspected that treatment is failing. Time at which nonresponse to treatment was suspected varied from practitioner to practitioner and was as less as one month to as long as 8 months but most (45 out of 50; 90%) were suspecting it early (within three months of therapy) (Table 6). Most common actions reported by 58 paediatricians included advising sputum culture and drug sensitivity test (35; 60.3%), suspecting and investigating for HIV infection (26; 44.8%), and prescribing another regimen (23; 39.7%). Since practices related to HIV-TB coinfection are not part of the paper, we have presented actions taken by paediatricians for HIV negative nonresponders in Figure 1. One paediatrician mentioned not coming across a nonresponder in practice. Out of the other remaining 63, four (6.3%) did not answer the question and 36 (57.1%) said that they investigate for MDR, whereas 23 (36.5%) mentioned that they prescribe another regimen (details of these regimens are provided subsequently). A total of 50 paediatricians answered question regarding time of suspecting drug-resistant TB, out of which 23 (46%) suspected only after trying second regimen (Table 6). Remaining 27 (54%) reported suspecting drug-resistance during first regimen itself, if sputum was positive at end of first (3; 11.1%), second (17; 63.0%), or third month (7; 25.9%) of therapy, respectively. Thus, 24 (48%) were suspecting drug-resistance at appropriate time (2 to 3 months), all of whom were testing for rifampicin resistance. A total of 31 paediatricians listed conditions when they suspected drug-resistance at beginning of treatment, two-thirds of them listed contact with case of drug-resistant TB, one-third investigated for resistance among HIV positive children, and only four (12.9%) reported suspecting resistance in cases treated with antitubercular drugs in the past. Almost all (48; 94.1%) paediatricians reported that basis of diagnosis of drug-resistance was bacteriological (Table 6). 33 of these who specified the type of test conducted reported use of sputum culture and drug sensitivity (reported by 10) or Xpert MTB/RIF (8) or both (15). Of the 35 who mentioned name of testing laboratories, 27 (77.1%) named laboratories that were accredited by national programme for drug-resistance testing whereas 8 (22.9%) were sending patients to nonaccredited laboratories.

Bottom Line: Sputum negative TB suspect is always tested with X-ray or tuberculin skin test. 61.4% prescribe regimen as recommended in ISTC and all monitor progress to treatment clinically.Drug-resistance at beginning of treatment is suspected for child in contact with a drug-resistant patient (67.7%) and with prior history of antitubercular treatment (12.9%).About half of them (48%) request drug-resistance test for rifampicin in case of nonresponse after two to three months of therapy and regimen prescribed by 41.7% for multidrug-resistant TB was as per ISTC.

View Article: PubMed Central - PubMed

Affiliation: School of Health Systems Studies, Tata Institute of Social Sciences, Sion-Trombay Road, Deonar, Mumbai, Maharashtra 400 088, India.

ABSTRACT
Majority of children with tuberculosis are treated in private sector in India with no available data on management practices. The study assessed diagnostic and treatment practices related to childhood pulmonary tuberculosis among paediatricians in Mumbai's private sector in comparison with International Standards for Tuberculosis Care (ISTC) 2009. In this cross-sectional study, 64 paediatricians from private sector filled self-administered questionnaires. Cough was reported as a symptom of childhood TB by 77.8% of respondents. 38.1% request sputum smear or culture for diagnosis and fewer (32.8%) use it for patients positive on chest radiographs and 32.8% induce sputum for those unable to produce it. Sputum negative TB suspect is always tested with X-ray or tuberculin skin test. 61.4% prescribe regimen as recommended in ISTC and all monitor progress to treatment clinically. Drug-resistance at beginning of treatment is suspected for child in contact with a drug-resistant patient (67.7%) and with prior history of antitubercular treatment (12.9%). About half of them (48%) request drug-resistance test for rifampicin in case of nonresponse after two to three months of therapy and regimen prescribed by 41.7% for multidrug-resistant TB was as per ISTC. The study highlights inappropriate diagnostic and treatment practices for managing childhood pulmonary TB among paediatricians in private sector.

No MeSH data available.


Related in: MedlinePlus