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      Risk factors in patients with AFB smear-positive sputum who receive inappropriate antituberculous treatment

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          Abstract

          Background

          Acid-fast bacilli (AFB) smear-positive sputum is usually an initial clue in the diagnosis of pulmonary tuberculosis (TB); however, the test is not disease-specific. Nontuberculous mycobacterium-related colonization or lung disease often has AFB smear-positive sputum results, and physicians may prescribe unnecessary antituberculous drugs for these patients. The aim of this study was to analyze the clinical characteristics of patients with AFB smear-positive sputum who received unnecessary anti-TB treatment.

          Methods and patients

          From January 2008 to July 2011, we retrospectively enrolled 97 patients with AFB smear-positive sputum who did not have pulmonary TB according to mycobacterial cultures and clinical judgment. We analyzed the clinical and radiographic features of the patients who received inappropriate and unnecessary anti-TB treatment. Preliminary analyses of chisquare and Fisher’s exact tests were applied to determine factors unlikely to be associated with the independent variables. The relationship between independent covariates was then analyzed using multivariate logistic regression.

          Results

          Of the 97 enrolled patients, 25 (25.8%) were diagnosed with pulmonary TB and prescribed anti-TB drugs (mostly a combination of isoniazid, rifampicin, ethambutol, and pyrazinamide). The other 72 (74.2%) patients were not initially diagnosed with pulmonary TB and were classified as the control group. Compared to the control group, the patients who received inappropriate anti-TB treatment had more chronic cough as presentation symptom and heavy AFB Ziehl–Neelsen staining in sputum (>10/100 fields, grading 2+ to 4+). There were no significant differences in the radiographic analysis between the two groups.

          Conclusion

          Among the patients with AFB smear-positive sputum that did not have pulmonary TB, chronic cough and heavy AFB staining (2+ to 4+) were risk factors for the inappropriate administration of unnecessary anti-TB treatment.

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          Author and article information

          Journal
          Drug Des Devel Ther
          Drug Des Devel Ther
          Drug Design, Development and Therapy
          Dove Medical Press
          1177-8881
          2013
          31 January 2013
          : 7
          : 53-58
          Affiliations
          [1 ]Division of Chest Medicine, Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan
          [2 ]Department of Internal Medicine, National Yang-Ming University, Taipei, Taiwan
          [3 ]Department of Radiology, National Yang-Ming University, Taipei, Taiwan
          [4 ]Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
          [5 ]Department of Industrial Management and Enterprise Information, Aletheia University, Taipei, Taiwan
          [6 ]Department of Laboratory Medicine, National Yang-Ming University Hospital, Yilan, Taiwan
          Author notes
          Correspondence: Shih-Chieh Chang Department of Internal Medicine, National Yang-Ming University Hospital, No 152, Xin-Min Road, Yilan City 260, Taiwan Tel +88 63 932 5192 ext 3652 Fax +88 63 936 5432 Email dtsurga9@ 123456yahoo.com.tw
          [*]

          These authors contributed equally to this work

          Article
          dddt-7-053
          10.2147/DDDT.S39247
          3563317
          23386785
          © 2013 Chang et al, publisher and licensee Dove Medical Press Ltd

          This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

          Categories
          Original Research

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