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National Collaborating Centre for Chronic Conditions (UK). Tuberculosis: Clinical Diagnosis and Management of Tuberculosis, and Measures for Its Prevention and Control. London: Royal College of Physicians (UK); 2006. (NICE Clinical Guidelines, No. 33.)

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

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Tuberculosis: Clinical Diagnosis and Management of Tuberculosis, and Measures for Its Prevention and Control.

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Preface

Tuberculosis, or TB, is one of man’s oldest foes and for centuries among the most feared. One of the triumphs of modern medicine has been the development of vaccination and medication capable of combating this ancient disease, and it now rarely troubles the thoughts of those born into modern Western society. Yet TB remains capable of exciting occasional major concern, for example when reports of local outbreaks emerge, and this continuing wariness is appropriate. Although TB notifications fell steadily for most of the twentieth century, this fall was not maintained in the last decade. Some racial groups have much higher TB incidence than others and, irrespective of ethnicity, the disease is more common in those in deprived social circumstances. Moreover, there are huge reservoirs of TB elsewhere in the world, with the additional spectre of growing pockets of infection resistant to available treatment. For all these reasons it is still necessary to focus attention on the optimum management of TB, and that is the purpose of this guideline.

The guideline has been commissioned by NICE as a successor to the British Thoracic Society’s TB guidelines, which have been used with great benefit for many years as the principal source of advice on TB management in the UK. The scope of the guideline is unusually wide, and we were obliged to divide the work between two separate guideline development groups, one covering diagnosis and management, the other prevention and control. Both groups used what has become our standard methodology, first identifying the key aspects of the disease and then searching out and appraising the best relevant evidence. In some areas, particularly those around prevention and control, it has been unusually difficult to find strong evidence. In all cases the guideline groups have attempted to produce practical recommendations, however much or little evidence they had to work on. In addition, great efforts were made to link the advice contained in the guideline to that available from other sources, in particular advice from the Joint Committee on Vaccination and Immunisation.

Although TB will not affect the majority of the UK population, some of the recommendations in the guideline will do so. For years, all secondary school children have been given Bacille Calmette-Guèrin (BCG) vaccination through the schools programme. The current epidemiology of TB in the UK suggests that this is inappropriate and that vaccination efforts should be targeted towards those most at risk, with a change in emphasis towards offering BCG to neonates. This will bring challenges for implementation, and this is not the only recommendation in the guideline which will do so. Directly observed therapy is not necessary as a routine, but is appropriate in those unlikely to adhere to the required treatment regime. This will necessitate careful risk assessment. The guideline also recommends that all people with TB should have a key worker to help educate and promote treatment adherence. These measures are important to the individuals with TB and to the wider community since effective management of patients and contacts is critical to avoiding the development and spread of drug-resistant TB.

The two guideline development groups have each had to meet their own challenges in the development of this document. Their sincere desire to get the best for patients with TB has been evident to those of us involved in the administration of the project, and we are grateful to them for this commitment as well as their expertise. Particular thanks are due to the clinical advisor, Peter Ormerod, who sat on both groups. I believe their efforts have resulted in a comprehensive and authoritative guideline, which should serve the NHS well in the short and medium term and provide a firm basis for future development and improvement in TB management.

Dr Bernard Higgins MD FRCP

Director, National Collaborating Centre for Chronic Conditions

Copyright © 2006, Royal College of Physicians of London.

All rights reserved. No part of this publication may be reproduced in any form (including photocopying or storing it in any medium by electronic means and whether or not transiently or incidentally to some other use of this publication) without the written permission of the copyright owner. Applications for the copyright owner’s written permission to reproduce any part of this publication should be addressed to the publisher.

Bookshelf ID: NBK45820

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