The management of pulmonary and lymph node tuberculosis notified in England and Wales in 1998.

The management of 1,337 cases of pulmonary tuberculosis and 422 cases of lymph node tuberculosis reported to the 1998 national notification survey was compared with the recommended standards of treatment. Most patients (84%) were under the care of thoracic physicians. Culture confirmation was obtained in 67.5% of pulmonary cases and 52% of lymph node cases. Drug resistance was reported in 7%, ranging from 3.3% in white patients to 7.9-8.2% in other ethnic groups. Only a minority of non-white ethnic patients received the recommended four-drug initial phase of therapy. Non-standard durations of initial and/or continuation therapy were used in 35% of cases on recommended drug combinations. Thirty-nine (2.9%) pulmonary cases were diagnosed only at post-mortem and a further 96 died before the end of the survey period, 55 (4.3%) due to tuberculosis. The outcome for pulmonary disease, with 80% cured or completing treatment, compare favourably with European outcome data. Although overall outcome data were satisfactory, more patients should have received a four-drug initial phase, with more combination tablet use and better compliance monitoring. Outcome monitoring will henceforth be based mainly on the continuous enhanced surveillance system introduced since 1999.