Management of tuberculosis in Wales: 1986–92

Objectives—To describe the epidemiology of childhood tuberculosis in Wales and to assess the standard of management of patients with tuberculosis. Design—Retrospective study of data re-trieved from case notes and review of radiographs of all identified patients. Subjects—Forty eight cases of tuberculo-sis and 10 of tuberculosis chemoprophy-laxis in children under 15 years of age, in Wales, between January 1986 and Decem-ber 1992. Main outcome measures—Management of childhood tuberculosis in Wales com-pared with the published recommenda-tions of the Joint Tuberculosis Committee of the British Thoracic Society. Results—Documentation was poor in most of the 48 cases of tuberculosis and only 31 (65%) were formally notified. One third of patients were asymptomatic and were detected by contact tracing; only eight (17%) were culture positive. Only 20 % of patients from ethnic minorities had previously been immunised with BCG. Management and chemotherapy varied widely. Few patients were managed jointly by paediatricians and chest doc-tors. Only 10 % completed treatment with a recommended chemotherapy regimen. In 37 % of patients treatment was inad-equate, and in the remainder either the choice of drugs or the duration of treat-ment was inappropriate. No patient died, nor had any relapsed by June 1995. Conclusions—Very few cases of childhood tuberculosis were managed according to the recommendations of the British Tho-racic Society