Prescription practice of anti-tuberculosis drugs in Yunnan, China: A clinical audit

Lin Xu, Jinou Chen, Anh L. Innes, Ling Li, Chen Yuan Chiang

研究成果: 雜誌貢獻文章

摘要

Objectives: China has a high burden of drug-resistant tuberculosis (TB). As irrational use and inadequate dosing of anti-TB drugs may contribute to the epidemic of drug-resistant TB, we assessed the drug types and dosages prescribed in the treatment of TB cases in a representative sample of health care facilities in Yunnan. Methods: We applied multistage cluster sampling using probability proportion to size to select 28 counties in Yunnan. Consecutive pulmonary TB patients were enrolled from either the TB centers of Yunnan Center of Disease Control or designated TB hospitals. Outcomes of interest included the regimen used in the treatment of new and retreatment TB patients; and the proportion of patients treated with adequate dosing of anti-TB drugs. Furthermore, we assess whether there has been reduction in the use of fluoroquinolone and second line injectables in Tuberculosis Clinical Centre (TCC) after the training activity in late 2012. Results: Of 2390 TB patients enrolled, 582 (24.4%) were prescribed second line anti-TB drugs (18.0% in new cases and 60.9% in retreatment cases); 363(15.2%) prescribed a fluoroquinolone. General hospitals (adjusted odds ratio (adjOR) 1.97, 95% confidence interval (CI) 1.47–2.66), retreatment TB cases (adjOR 4.75, 95% CI 3.59–6.27), smear positive cases (adjOR 1.69, 95% CI 1.22–2.33), and extrapulmonary TB (adjOR 2.59, 95% CI 1.66–4.03) were significantly associated with the use of fluoroquinolones. The proportion of patients treated with fluoroquinolones decreased from 41.4% before 2013 to 13.5% after 2013 (adjOR 0.19, 95% CI 0.12–0.28) in TCC. The proportion of patients with correct, under and over dosages of isoniazid was 88.2%, 1.5%, and 10.4%, respectively; of rifampicin was 50.2%, 46.8%, and 2.9%; of pyrazinamide was 67.6%, 31.7% and 0.7%; and of ethambutol was 41.4%, 57.5%, and 1.0%. Conclusions: The prescribing practice of anti-TB drugs was not standardized, findings with significant programmatic implication.

原文英語
文章編號e0187076
期刊PLoS One
12
發行號10
DOIs
出版狀態已發佈 - 十月 1 2017

指紋

Clinical Audit
audits
tuberculosis
Prescriptions
China
Tuberculosis
Fluoroquinolones
drugs
Pharmaceutical Preparations
Odds Ratio
fluoroquinolones
Retreatment
odds ratio
Confidence Intervals
confidence interval
Multidrug-Resistant Tuberculosis
Disease control
Pyrazinamide
Ethambutol
Isoniazid

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

引用此文

Prescription practice of anti-tuberculosis drugs in Yunnan, China : A clinical audit. / Xu, Lin; Chen, Jinou; Innes, Anh L.; Li, Ling; Chiang, Chen Yuan.

於: PLoS One, 卷 12, 編號 10, e0187076, 01.10.2017.

研究成果: 雜誌貢獻文章

Xu, Lin ; Chen, Jinou ; Innes, Anh L. ; Li, Ling ; Chiang, Chen Yuan. / Prescription practice of anti-tuberculosis drugs in Yunnan, China : A clinical audit. 於: PLoS One. 2017 ; 卷 12, 編號 10.
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title = "Prescription practice of anti-tuberculosis drugs in Yunnan, China: A clinical audit",
abstract = "Objectives: China has a high burden of drug-resistant tuberculosis (TB). As irrational use and inadequate dosing of anti-TB drugs may contribute to the epidemic of drug-resistant TB, we assessed the drug types and dosages prescribed in the treatment of TB cases in a representative sample of health care facilities in Yunnan. Methods: We applied multistage cluster sampling using probability proportion to size to select 28 counties in Yunnan. Consecutive pulmonary TB patients were enrolled from either the TB centers of Yunnan Center of Disease Control or designated TB hospitals. Outcomes of interest included the regimen used in the treatment of new and retreatment TB patients; and the proportion of patients treated with adequate dosing of anti-TB drugs. Furthermore, we assess whether there has been reduction in the use of fluoroquinolone and second line injectables in Tuberculosis Clinical Centre (TCC) after the training activity in late 2012. Results: Of 2390 TB patients enrolled, 582 (24.4{\%}) were prescribed second line anti-TB drugs (18.0{\%} in new cases and 60.9{\%} in retreatment cases); 363(15.2{\%}) prescribed a fluoroquinolone. General hospitals (adjusted odds ratio (adjOR) 1.97, 95{\%} confidence interval (CI) 1.47–2.66), retreatment TB cases (adjOR 4.75, 95{\%} CI 3.59–6.27), smear positive cases (adjOR 1.69, 95{\%} CI 1.22–2.33), and extrapulmonary TB (adjOR 2.59, 95{\%} CI 1.66–4.03) were significantly associated with the use of fluoroquinolones. The proportion of patients treated with fluoroquinolones decreased from 41.4{\%} before 2013 to 13.5{\%} after 2013 (adjOR 0.19, 95{\%} CI 0.12–0.28) in TCC. The proportion of patients with correct, under and over dosages of isoniazid was 88.2{\%}, 1.5{\%}, and 10.4{\%}, respectively; of rifampicin was 50.2{\%}, 46.8{\%}, and 2.9{\%}; of pyrazinamide was 67.6{\%}, 31.7{\%} and 0.7{\%}; and of ethambutol was 41.4{\%}, 57.5{\%}, and 1.0{\%}. Conclusions: The prescribing practice of anti-TB drugs was not standardized, findings with significant programmatic implication.",
author = "Lin Xu and Jinou Chen and Innes, {Anh L.} and Ling Li and Chiang, {Chen Yuan}",
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T2 - A clinical audit

AU - Xu, Lin

AU - Chen, Jinou

AU - Innes, Anh L.

AU - Li, Ling

AU - Chiang, Chen Yuan

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Objectives: China has a high burden of drug-resistant tuberculosis (TB). As irrational use and inadequate dosing of anti-TB drugs may contribute to the epidemic of drug-resistant TB, we assessed the drug types and dosages prescribed in the treatment of TB cases in a representative sample of health care facilities in Yunnan. Methods: We applied multistage cluster sampling using probability proportion to size to select 28 counties in Yunnan. Consecutive pulmonary TB patients were enrolled from either the TB centers of Yunnan Center of Disease Control or designated TB hospitals. Outcomes of interest included the regimen used in the treatment of new and retreatment TB patients; and the proportion of patients treated with adequate dosing of anti-TB drugs. Furthermore, we assess whether there has been reduction in the use of fluoroquinolone and second line injectables in Tuberculosis Clinical Centre (TCC) after the training activity in late 2012. Results: Of 2390 TB patients enrolled, 582 (24.4%) were prescribed second line anti-TB drugs (18.0% in new cases and 60.9% in retreatment cases); 363(15.2%) prescribed a fluoroquinolone. General hospitals (adjusted odds ratio (adjOR) 1.97, 95% confidence interval (CI) 1.47–2.66), retreatment TB cases (adjOR 4.75, 95% CI 3.59–6.27), smear positive cases (adjOR 1.69, 95% CI 1.22–2.33), and extrapulmonary TB (adjOR 2.59, 95% CI 1.66–4.03) were significantly associated with the use of fluoroquinolones. The proportion of patients treated with fluoroquinolones decreased from 41.4% before 2013 to 13.5% after 2013 (adjOR 0.19, 95% CI 0.12–0.28) in TCC. The proportion of patients with correct, under and over dosages of isoniazid was 88.2%, 1.5%, and 10.4%, respectively; of rifampicin was 50.2%, 46.8%, and 2.9%; of pyrazinamide was 67.6%, 31.7% and 0.7%; and of ethambutol was 41.4%, 57.5%, and 1.0%. Conclusions: The prescribing practice of anti-TB drugs was not standardized, findings with significant programmatic implication.

AB - Objectives: China has a high burden of drug-resistant tuberculosis (TB). As irrational use and inadequate dosing of anti-TB drugs may contribute to the epidemic of drug-resistant TB, we assessed the drug types and dosages prescribed in the treatment of TB cases in a representative sample of health care facilities in Yunnan. Methods: We applied multistage cluster sampling using probability proportion to size to select 28 counties in Yunnan. Consecutive pulmonary TB patients were enrolled from either the TB centers of Yunnan Center of Disease Control or designated TB hospitals. Outcomes of interest included the regimen used in the treatment of new and retreatment TB patients; and the proportion of patients treated with adequate dosing of anti-TB drugs. Furthermore, we assess whether there has been reduction in the use of fluoroquinolone and second line injectables in Tuberculosis Clinical Centre (TCC) after the training activity in late 2012. Results: Of 2390 TB patients enrolled, 582 (24.4%) were prescribed second line anti-TB drugs (18.0% in new cases and 60.9% in retreatment cases); 363(15.2%) prescribed a fluoroquinolone. General hospitals (adjusted odds ratio (adjOR) 1.97, 95% confidence interval (CI) 1.47–2.66), retreatment TB cases (adjOR 4.75, 95% CI 3.59–6.27), smear positive cases (adjOR 1.69, 95% CI 1.22–2.33), and extrapulmonary TB (adjOR 2.59, 95% CI 1.66–4.03) were significantly associated with the use of fluoroquinolones. The proportion of patients treated with fluoroquinolones decreased from 41.4% before 2013 to 13.5% after 2013 (adjOR 0.19, 95% CI 0.12–0.28) in TCC. The proportion of patients with correct, under and over dosages of isoniazid was 88.2%, 1.5%, and 10.4%, respectively; of rifampicin was 50.2%, 46.8%, and 2.9%; of pyrazinamide was 67.6%, 31.7% and 0.7%; and of ethambutol was 41.4%, 57.5%, and 1.0%. Conclusions: The prescribing practice of anti-TB drugs was not standardized, findings with significant programmatic implication.

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