Initial Drug Regimens for the Treatment of Tuberculosis: Discussion
These results indicate that physicians in New Jersey may not be aware of the recommendations or of the level of drug resistance in their communities. Therefore, an effort should be made to inform physicians about the importance of initiating four-dmg regimens to treat TB patients and about the high level of drug resistance in the communities they serve.
The most significant finding of this study is the strong association between initial care providers and initial drug regimens. It is remarkable that only 8% of the TB patients at UMDNJ-MS were initially treated with fewer than four drugs, compared with 37% at other hospitals, 42% at other chest clinics, and 52% at private physicians’ offices. After adjustment for patient characteristics and drug-resistant status, private physicians and physicians at other chest clinics were still much more likely to prescribe an initial drug regimen of fewer than four drugs. It is not known exactly why private practitioners and physicians at chest clinics were less likely to follow the CDC/ATS recommendation for an initial fourdrug regimen. There are three possible explanations for the failure of these physicians to prescribe four-drug regimens. First, the physicians may be unaware of the recommendations. Second, the physicians may be aware of the recommendations but be unaware that there is a high level of drug resistance in the communities that they serve. Third, the physicians may be aware of the recommendations and the high level of drug resistance but may not consider their individual patients to be at risk. Further research is needed to determine which of these factors contribute to the failure of physicians to treat patients in accordance with the ATS/CDC recommendations.
In summary, the results suggest that physicians should be further educated about the CDC/ATS recommendations and the high proportion of drug-resistant TB in the communities they serve to assure that persons with TB receive appropriate initial therapy.