Review - Reviewer's Assessment

1. Short summary / abstract
These guidelines update the previous guidance produced by the Joint Tuberculosis Committee of the BTS on chemotherapy issued in 1990and on treatment of dual infections with HIV in 1992.
They include background information on the need to update previous guidance detailed treatment for adults, children and special groups, the role of directly observed therapy (DOT), clinical management of tuberculosis and an appendix on infection control in health care facilities.
The recommendations include: -
Patients with tuberculosis should be notified
Bacteriological confirmation and drug susceptibility testing should be sought whenever possible
A six month short course regimen, with four drugs in the initial phase, should be used for all tuberculosis except meningitis in both adults and children
The fourth drug (ethambutol) can be omitted in the initial phase in certain circumstances
Treatment of all patients should be supervised by experts in the specialty
Advice is given on management of any special difficulties, drug interactions, special precautions and pre-treatment screening, chemoprophylaxis, management of single and multiple drug resistance
Advice is given on follow up treatment and the services available
The role of DOT
The management of multi-drug resistant tuberculosis is explained in detail including the role of appropriate isolation facilities
Infection control for patients with tuberculosis and with dual infection with human immunodeficiency virus (HIV)
The guidance has taken account of new published evidence and recent epidemiology of the disease and increasing problems of drug resistance.


2. What question is the document addressing?
The document outlines the guidance on recommended treatment, management of chemotherapy, clinical management and infection control in health care facilities of patients with tuberculosis and dual infection with HIV.

3. Type of study
Review of previous guidance/evidence and new published evidence

4. Methods valid & appropriate?
Yes

Comments:
This guidance is at present being updated?

5. Results / recommendations reliable?
The guidance has been approved by the JTC and the Standards of Care Committee of the British Thoracic Society. Recommendations have been graded based on the Agency for Health Care Policy and Research (AHCPR 1994)

6. Any major problems and biases?
This guidance is at present being updated?

7. Any other important / relevant studies which confirm or contradict?
1. Department of Health. Stopping Tuberculosis in England: An Action Plan from the Chief Medical Officer October 2004 www.dh.gov.uk/publications
2. Joint Tuberculosis Committee of the British Thoracic Society: Control and prevention of tuberculosis in the United Kingdom: Code of Practice 2000Thorax 2000; 55: 887-901
3. Joint Tuberculosis Committee of the British Thoracic Society: Code of Practice 1994, Thorax 1994; 49: 1193-1200
4. International Council of Nurses. TB Guidelines for Nurses in the Care and Control of Tuberculosis and Multi-Drug Resistant Tuberculosis. (2005) http://www.icn.ch
The International Council of Nurses has launched an online Global TB Resource Centre ( www.icn.ch/tb/ ) – which provides multiple tools for both generalist and specialist nurses treating and caring for patients with tuberculosis and multi-drug resistant tuberculosis (MDR-TB)


8. Keywords
Tuberculosis BTS guidelines multi-drug resistance chemoprophylaxis directly observed therapy (DOT) mycobacterium isolation



Reviewer's Details:

Name:Sue Wiseman
Post:Nurse Consultant –Infection Control, DH
Affiliations
(Society / Organisation / Advisory Committee):
Member Advisory Committee on Dangerous Pathogens
Health Protection Adviser Royal College of Nursing P/T
Member Infection Control Nurses Association


*** Note: These are the views of a professional expert rather than an official statement from his or her society, organisation or advisory committee.






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