Clinical standards for drug-susceptible pulmonary TB.

Akkerman, OW; Duarte, R; Tiberi, S; Schaaf, HS; Lange, C; Alffenaar, JWC; Denholm, J; Carvalho, ACC; Bolhuis, MS; Borisov, S; +37 more...Bruchfeld, J; Cabibbe, AM; Caminero, JA; Carvalho, I; Chakaya, J; Centis, R; Dalcomo, MP; D Ambrosio, L; Dedicoat, M; Dheda, KORCID logo; Dooley, KE; Furin, J; García-García, J-M; van Hest, NAH; de Jong, BC; Kurhasani, X; Märtson, AG; Mpagama, S; Torrico, M Munoz; Nunes, E; Ong, CWM; Palmero, DJ; Ruslami, R; Saktiawati, AMI; Semuto, C; Silva, DR; Singla, R; Solovic, I; Srivastava, S; de Steenwinkel, JEM; Story, A; Sturkenboom, MGG; Tadolini, M; Udwadia, ZF; Verhage, AR; Zellweger, JP; and Migliori, GB (2022) Clinical standards for drug-susceptible pulmonary TB. International Journal of Tuberculosis and Lung Disease, 26 (7). pp. 592-604. ISSN 1027-3719 DOI: 10.5588/ijtld.22.0228
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BACKGROUND: The aim of these clinical standards is to provide guidance on 'best practice´ for diagnosis, treatment and management of drug-susceptible pulmonary TB (PTB).METHODS: A panel of 54 global experts in the field of TB care, public health, microbiology, and pharmacology were identified; 46 participated in a Delphi process. A 5-point Likert scale was used to score draft standards. The final document represents the broad consensus and was approved by all 46 participants.RESULTS: Seven clinical standards were defined: Standard 1, all patients (adult or child) who have symptoms and signs compatible with PTB should undergo investigations to reach a diagnosis; Standard 2, adequate bacteriological tests should be conducted to exclude drug-resistant TB; Standard 3, an appropriate regimen recommended by WHO and national guidelines for the treatment of PTB should be identified; Standard 4, health education and counselling should be provided for each patient starting treatment; Standard 5, treatment monitoring should be conducted to assess adherence, follow patient progress, identify and manage adverse events, and detect development of resistance; Standard 6, a recommended series of patient examinations should be performed at the end of treatment; Standard 7, necessary public health actions should be conducted for each patient. We also identified priorities for future research into PTB.CONCLUSION: These consensus-based clinical standards will help to improve patient care by guiding clinicians and programme managers in planning and implementation of locally appropriate measures for optimal person-centred treatment for PTB.


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