Tuberculosis in Scotland: A national sample survey (1968–1970) 2. A two-year follow-up of newly-diagnosed respiratory tuberculosis notified in 1968

Abstract

The methods and results of therapy during a two-year period of follow-up have been studied in a 50 % random sample of the newly notified cases of pulmonary tuberculosis in Scotland for the year 1968. Of the 770 patients, 1.9 % died of active tuberculosis, 2.6 % were bacteriological failures, the regimen was changed for initial drug resistance in 0.9 % and for drug toxicity in 2.6 %. Default from chemotherapy in the first year occurred in 8.1 % of patients, 4.7 % absconding permanently. The bacteriological failure rate in the 372 positive cases was 7.3 %. A further 20 patients were diagnosed at necropsy, 16 having died of the disease. Eighty-seven per cent of 372 initially positive patients were in hospital for an average of 18.0 weeks and 65 % of 309 initially negative patients for an average of 11.0 weeks. Eighty per cent of the positive patients received streptomycin plus PAS plus isoniazid and a further 10 % PAS plus isoniazid, the proportions for the negative patients being 57 % and 35 %. Side effects occurred in 53 % of the patients on the triple regimen and 43 % of those on PAS plus isoniazid. The mean duration of chemotherapy for the bacteriologically positive patients was 22.2 months and for those negative 19.1 months, the duration of the initial streptomycin supplement being 4.4 months and 3.4 months, respectively. Corticosteroids were given to 58 (8 %) of the 770 patients. Only 6 (0.8 %) had surgery for their tuberculosis. Forty-one per cent of the positive patients were off work for more than 6 months and 19 % of the negative patients, and 18 % and 8 % never returned to work. In the two-year period an average of 12.5 radiographs were taken per patient and 10.8 bacteriological specimens were examined for tubercle bacilli. The number of clinic attendances in a full out-patient year averaged 4.2. Urine tests for antituberculosis drugs (invariably PAS) were performed in only 6 of 25 Burghs and 5 of 14 Counties, and were done infrequently in them. A continuous evaluation procedure for tuberculosis therapy programmes is recommended.