Trial-of-antibiotic algorithm for the diagnosis of tuberculosis in a district hospital in a developing country with high HIV prevalence.

Abstract

OBJECTIVE:

To evaluate a diagnostic algorithm for pulmonary tuberculosis based on smear microscopy and objective response to trial of antibiotics.

SETTING:

Adult medical wards, Hlabisa Hospital, South Africa, 1996-1997.

METHODS:

Adults with chronic chest symptoms and abnormal chest X-ray had sputum examined for Ziehl-Neelsen stained acid-fast bacilli by light microscopy. Those with negative smears were treated with amoxycillin for 5 days and assessed. Those who had not improved were treated with erythromycin for 5 days and reassessed. Response was compared with mycobacterial culture.

RESULTS:

Of 280 suspects who completed the diagnostic pathway, 160 (57%) had a positive smear, 46 (17%) responded to amoxycillin, 34 (12%) responded to erythromycin and 40 (14%) were treated as smear-negative tuberculosis. The sensitivity (89%) and specificity (84%) of the full algorithm for culture-positive tuberculosis were high. However, 11 patients (positive predictive value [PPV] 95%) were incorrectly diagnosed with tuberculosis, and 24 cases of tuberculosis (negative predictive value [NPV] 70%) were not identified. NPV improved to 75% when anaemia was included as a predictor. Algorithm performance was independent of human immunodeficiency virus status.

CONCLUSION:

Sputum smear microscopy plus trial of antibiotic algorithm among a selected group of tuberculosis suspects may increase diagnostic accuracy in district hospitals in developing countries.

• Authors: D Wilkinson, W Newman, A Reid, S B Squire, A W Sturm, C F Gilks
• Journal: The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease (Int J Tuberc Lung Dis) Vol. 4 Issue 6 Pg. 513-8 (Jun 2000) ISSN: 1027-3719 [Print] France
• PMID: 10864181 (Publication Type: Journal Article)

Chemical References

• Anti-Bacterial Agents
• Penicillins
• Erythromycin
• Amoxicillin

Topics

• AIDS-Related Opportunistic Infections (diagnosis, drug therapy)
• Adult
• Algorithms
• Amoxicillin (therapeutic use)
• Anti-Bacterial Agents (therapeutic use)
• Erythromycin (therapeutic use)
• Female
• Hospitals, District
• Humans
• Male
• Middle Aged
• Penicillins (therapeutic use)
• Prospective Studies
• Sensitivity and Specificity
• South Africa
• Sputum (microbiology)
• Tuberculosis, Pulmonary (diagnosis, drug therapy)