Management of tuberculosis in Wales: 1986-92

Abstract

Objectives - To describe the epidemiology of childhood tuberculosis in Wales and to assess the standard of management of patients with tuberculosis. Design - Retrospective study of data retrieved from case notes and review of radiographs of all identified patients. Subjects - Forty eight cases of tuberculosis and 10 of tuberculosis chemoprophylaxis in children under 15 years of age, in Wales, between January 1986 and December 1992. Main outcome measures - Management of childhood tuberculosis in Wales compared with the published recommendations of the Joint Tuberculosis Committee of the British Thoracic Society. Results - Documentation was poor in most of the 48 cases of tuberculosis and only 31 (65%) were formally notified. One third of patients were asymptomatic and were detected by contact tracing; only eight (17%) were culture positive. Only 20% of patients from ethnic minorities had previously been immunised with BCG. Management and chemotherapy varied widely. Few patients were managed jointly by paediatricians and chest doctors. Only 10% completed treatment with a recommended chemotherapy regimen. In 37% of patients treatment was inadequate, and in the remainder either the choice of drugs or the duration of treatment was inappropriate. No patient died, nor had any relapsed by June 1995. Conclusions - Very few cases of childhood tuberculosis were managed according to the recommendations of the British Thoracic Society.