Management and outcome of pulmonary tuberculosis in adults notified in England and Wales in 1983. Medical Research Council Tuberculosis and Chest Diseases Unit.

The management and outcome of treatment were studied, two years or more after notification, in previously untreated adult patients of white and Indian subcontinent (Indian, Pakistani, and Bangladeshi) ethnic origin with pulmonary tuberculosis notified in England and Wales in the first six months of 1983. Of the 1068 patients, 10% had died, 3% defaulted, and 1% left the UK before completing chemotherapy. Of the 917 patients who completed chemotherapy, 90% were prescribed rifampicin and isoniazid throughout, most having ethambutol in addition either in the initial phase only (72%) or throughout (3%); 18% had pyrazinamide. The outcome of chemotherapy at the time the patient was last seen was reported by the clinician. Of those completing treatment, most were classified as cured after the primary course of chemotherapy (86%) or after modification of chemotherapy because of toxicity (10%) or therapeutic failure (2%). Altogether, 28 patients were classified as therapeutic failures because of a slow response, deterioration, or failure during chemotherapy or relapse after stopping chemotherapy. A further 151 patients, however, failed to complete chemotherapy, some for reasons attributable to a failure of the routine clinical services. This should prompt continued efforts to maximise the efficiency of the services for tuberculosis. The main differences between the findings of this survey and those of the previous Medical Research Council survey (of patients starting chemotherapy in 1978-9) were an increased use of pyrazinamide and a reduction in the duration of the chemotherapy prescribed.