Management of latent tuberculosis infections in australia and new zealand: a review of current practice.

AIM: To survey practices in the diagnosis and management of latent tuberculosis infection (LTBI) in Australia and New Zealand.

METHODS

Infectious diseases and respiratory physicians and trainees were invited to complete an online questionnaire concerning various aspects of LTBI management.

RESULTS

The questionnaire was completed by 126 clinicians self-reporting regular management of LTBI. Respondents were experienced physicians, with 95/126 (75.4%) having managed LTBI for more than 5 years. Forty-seven (37.3%) reported seeing more than 5 patients per month for assessment of LTBI. Substantial variation among clinicians was reported in relation to a number of common clinical scenarios. For instance, while 52/126 (43.7%) informed patients that the incidence of severe hepatotoxicity related to isoniazid monotherapy was 0.1-0.5%, 21/126 (15.7%) thought it was >5%. 36/126 (28.6%) clinicians would proceed with TNF-αtherapy following an indeterminate screening: interferon-γassay, while 78/126 (61.9%) would perform further investigations and 12/126 (9.5%) would initiate isoniazid therapy. Follow-up intervals during therapy varied from 1-3 monthly, with liver function testing performed routinely by 89/126 (70.6%).

CONCLUSION

This study demonstrated a large degree of variation in clinical practice of LTBI management in Australia and New Zealand. Strategies for increasing uniformity of practice are required, including improved guidelines and physician education.