Cumplimiento en España de la norma de prescribir cuatro fármacos en la fase intensiva del tratamiento estándar de la tuberculosis / Spanish Compliance With Guidelines for Prescribing Four Drugs in the Intensive Phase of Standard Tuberculosis Treatment

Introducción: Las normativas internacionales y españolas recomiendan el tratamiento intensivo de la tuberculosis (TB) con cuatro fármacos. El objetivo es determinar si en España se sigue esta recomendación y los factores asociados a utilizar tres fármacos (pauta estándar sin etambutol). Metodología: Estudio multicéntrico descriptivo, retrospectivo, en el que se analizaron los datos de los pacientes diagnosticados de TB en prácticamente todas las Comunidades Autónomas españolas entre 2007 y 2012. El estudio de factores asociados a prescribir tres fármacos se basó en regresión logística, calculándose las odds ratio (OR) y sus correspondientes intervalos de confianza del 95% (IC). Resultados: Se incluyeron 3.189 pacientes, de los que 1.413 (44,3%) fueron tratados con tres fármacos. Este porcentaje fue del 41,2% en los pacientes con baciloscopia positiva, del 36,1% en los que tenían al menos resistencia a un fármaco, del 31,4% en los que tenían infección por VIH y del 24,8% en los inmigrantes. Los factores asociados al uso de tres fármacos fueron: ser mujer (OR = 1,18; IC: 1,00-1,39); ser autóctono (OR = 3,09; IC: 2,58-3,70); estar jubilado (OR = 1,42; IC: 1,14-1,77); vivir sin techo (OR = 3,10; IC: 1,52-6,43), vivir solo (OR = 1,62; IC: 1,11-2,36) o en familia (OR = 1,97; IC: 1,48-2,65); ser atendido por especialistas de zona (OR = 1,37; IC: 1,10;1,70); no estar infectado por el VIH (OR = 1,63; IC: 1,09-2,48) y tener baciloscopia negativa con cultivo positivo (OR = 1,59; IC: 1,25-2,02). Conclusiones: Existe una proporción importante de tratamiento intensivo con tres fármacos. Se deben seguir las recomendaciones del tratamiento de la TB, tanto en la práctica clínica habitual como por parte del Plan para la Prevención y Control de la TB en España

Introduction: International and Spanish guidelines recommend a 4-drug regimen in the intensive treatment of tuberculosis (TB). The aim of our study was to determine if these recommendations are followed in Spain, and the factors associated with the use of 3 drugs (standard regimen without ethambutol). Methodology: Observational, multicenter, retrospective analysis of data from patients diagnosed with TB in practically all Spanish Autonomous Communities between 2007 and 2102. Factors associated with the use of 3 drugs were analyzed using logistic regression, and odds ratios (OR) and corresponding 95% confidence intervals (CI) were calculated. Results: A total of 3,189 patients were included, 1,413 (44.3%) of whom received 3 drugs. The percentage of 3-drug users among patients with positive sputum smear was 41.2%; among patients with resistance to at least 1 drug, 36.1%; among HIV-infected patients, 31.4%; and among immigrants, 24.8%. Factors associated with the use of 3 drugs were: female sex (OR = 1.18; CI: 1.00-1.39); native Spanish (OR = 3.09; CI: 2.58-3.70); retired (OR = 1.42; CI: 1.14-1.77); homeless (OR = 3.10; CI: 1.52-6.43); living alone (OR = 1.62; CI: 1.11-2.36); living in a family (OR = 1.97; CI: 1.48-2.65); seen by specialists in the region (OR = 1.37; CI: 1.10;1.70); no HIV infection (OR = 1.63; CI: 1.09-2.48); and negative sputum smear with positive culture (OR = 1.59; CI: 1.25-2.02). Conclusions: A large proportion of TB patients receive intensive treatment with 3 drugs. TB treatment recommendations should be followed, both in routine clinical practice and by the National Plan for Prevention and Control of Tuberculosis in Spain

Spanish Compliance With Guidelines for Prescribing Four Drugs in the Intensive Phase of Standard Tuberculosis Treatment. / Cumplimiento en España de la norma de prescribir cuatro fármacos en la fase intensiva del tratamiento estándar de la tuberculosis.

INTRODUCTION: International and Spanish guidelines recommend a 4-drug regimen in the intensive treatment of tuberculosis (TB). The aim of our study was to determine if these recommendations are followed in Spain, and the factors associated with the use of 3 drugs (standard regimen without ethambutol). METHODOLOGY: Observational, multicenter, retrospective analysis of data from patients diagnosed with TB in practically all Spanish Autonomous Communities between 2007 and 2102. Factors associated with the use of 3 drugs were analyzed using logistic regression, and odds ratios (OR) and corresponding 95% confidence intervals (CI) were calculated. RESULTS: A total of 3,189 patients were included, 1,413 (44.3%) of whom received 3 drugs. The percentage of 3-drug users among patients with positive sputum smear was 41.2%; among patients with resistance to at least 1 drug, 36.1%; among HIV-infected patients, 31.4%; and among immigrants, 24.8%. Factors associated with the use of 3 drugs were: female sex (OR=1.18; CI: 1.00-1.39); native Spanish (OR=3.09; CI: 2.58-3.70); retired (OR=1.42; CI: 1.14-1.77); homeless (OR=3.10; CI: 1.52-6.43); living alone (OR=1.62; CI: 1.11-2.36); living in a family (OR=1.97; CI: 1.48-2.65); seen by specialists in the region (OR=1.37; CI: 1.10;1.70); no HIV infection (OR=1.63; CI: 1.09-2.48); and negative sputum smear with positive culture (OR=1.59; CI: 1.25-2.02). CONCLUSIONS: A large proportion of TB patients receive intensive treatment with 3 drugs. TB treatment recommendations should be followed, both in routine clinical practice and by the National Plan for Prevention and Control of Tuberculosis in Spain.