Abstract
BackgroundIt was reported that 35.5% of tuberculosis (TB) cases reported in 2003 in Taipei City had no recorded pre-treatment body weight and that among those who had, inconsistent dosing of anti-TB drugs was frequent. Taiwan Centers for Disease Control (CDC) have taken actions to strengthen dosing of anti-TB drugs among general practitioners. Prescribing practices of anti-TB drugs in Taipei City in 2007–2010 were investigated to assess whether interventions on dosing were effective.Methodology/Principal FindingsLists of all notified culture positive TB cases in 2007–2010 were obtained from National TB Registry at Taiwan CDC. A medical audit of TB case management files was performed to collect pretreatment body weight and regimens prescribed at commencement of treatment. Dosages prescribed were compared with dosages recommended. The proportion of patients with recorded pre-treatment body weight was 64.5% in 2003, which increased to 96.5% in 2007–2010 (p<0.001). The proportion of patients treated with consistent dosing of a 3-drug fixed-dose combination (FDC) increased from 73.9% in 2003 to 87.7% in 2007–2010 (p<0.001), and that for 2-drug FDC from 76.0% to 86.1% (p = 0.024), for rifampicin (RMP) from 62.8% to 85.5% (p<0.001), and for isoniazid from 87.8% to 95.3% (p<0.001). In 2007–2010, among 2917 patients treated with either FDCs or RMP in single-drug preparation, the dosage of RMP was adequate (8–12 mg/kg) in 2571(88.1%) patients, too high in 282(9.7%), too low in 64(2.2%). In multinomial logistic regression models, factors significantly associated with adequate dosage of RMP were body weight and preparations of RMP. Patients weighting <40kg (relative risk ratio (rrr) 6010.5, 95% CI 781.1–46249.7) and patients weighting 40–49 kg (rrr 1495.3, 95% CI 200.6–11144.6) were more likely to receive higher-than-recommended dose of RMP.Conclusions/SignificancePrescribing practice in the treatment of TB in Taipei City has remarkably improved after health authorities implemented a series of interventions.
Highlights
Tuberculosis (TB) services were provided by general practitioners in Taiwan
Chiang and colleagues assessed general practitioners’ prescribing practice of anti-TB medicines in Taiwan and reported that 35.5% of TB cases reported in the year 2003 in Taipei City had no recorded pretreatment body weight and that among those who had, inconsistent dosing of anti-TB drugs was frequent [4]
Study population The study population included all individuals with culture positive for Mycobacterium tuberculosis who were citizens of Taipei City reported to Taiwan Centers for Disease Control (CDC) in the calendar year 2007–2010
Summary
Tuberculosis (TB) services were provided by general practitioners in Taiwan. TB was a notifiable disease by law. Completeness of TB notification in Taiwan has been investigated; 96.3% of patients who were prescribed 2 or more anti-TB drugs in 2005–2007 were notified to Taiwan Centers for Disease Control (CDC) [1]. Chiang and colleagues assessed general practitioners’ prescribing practice of anti-TB medicines in Taiwan and reported that 35.5% of TB cases reported in the year 2003 in Taipei City had no recorded pretreatment body weight and that among those who had, inconsistent dosing of anti-TB drugs was frequent [4]. It was reported that 35.5% of tuberculosis (TB) cases reported in 2003 in Taipei City had no recorded pretreatment body weight and that among those who had, inconsistent dosing of anti-TB drugs was frequent. Taiwan Centers for Disease Control (CDC) have taken actions to strengthen dosing of anti-TB drugs among general practitioners. Prescribing practices of anti-TB drugs in Taipei City in 2007–2010 were investigated to assess whether interventions on dosing were effective
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