Compliment del tractament tuberculostàtic entre la població visitada a l’Hospital del Mar de Barcelona. 10 anys de control / Cumplimiento del tratamiento tuberculostático entre la población atendida en el Hospital del Mar de Barcelona. 10 años de seguimiento / Compliance with tuberculostatic therapy among patients seen at Hospital del Mar in Barcelona. Ten-year follow up

RESUMEN

Fonament. L’èxit terapèutic tuberculostàtic es fonamenta en el correcte compliment. Objectiu. Valorar el compliment del tractament tuberculostàtic. Mètode. 109 infants. Metodologia: 1) verbalització, preguntes directes i indirectes; 2) comprovació colorimè- trica de presència de rifampicina i isoniazida a orina. Resultats. Malaltia tuberculosa: 36 casos (3 perduts); 27 fan totes visites. Compliment a totes visites 23 (71.8%); irregular 4. Taxa de compliment 81.25%. Infecció tuberculosa: 45 casos (2 perduts); 30 fan totes visites. Compliment correcte 24 (55.8%); irregular 13. Taxa de compliment 77.08%. Quimioprofilaxi primària: 28 casos. Compliment correcte 15; irregular 8. Conclusions. 1) El compliment terapèutic és fonamental per minvar malaltia. El millor mètode és el tractament directament observat, no sempre factible. 2) Les taxes de compliment (81.25 i 77.08%) són acceptables, però millorables. 3) La metodologia per a la valoració no és idònia, però és innòcua, fàcil, pràctica i de baix cost; 4) És imprescindible que el pediatre mentalitzi i eduqui en la importància de la malaltia i el compliment terapèutic. 5) Mantenir el mateix equip metge-infermeria pot afavorir adherències. 6) En tractaments curts és més fàcil el compliment (AU)

ABSTRACT

Background. The success of tuberculostatic therapy correlates directly with compliance. Objective. To evaluate the compliance with tuberculostatic treatment among a group of children seen at a single institution. Method. 109 children receiving different tuberculostatic regimens were evaluated for compliance. The methods used included: 1) disclosure in response to direct and indirect questions; 2) colorimetric test for the presence of rifampin and isoniazid in urine. Results. Among the 36 cases of pulmonary tuberculosis, 3 patients were lost to follow-up and 27 patients have complied with all the follow-up visits. Of those, good therapeutic compliance was documented in 23 patients (71.8%), and it was estimated to be irregular in 4 patients. Thus, the overall compliance rate for patients with pulmonary tuberculosis was 81.25%. Among the 45 cases of latent tuberculosis infection, 2 patients were lot to follow-up, and 30 patients complied with all the follow-up visits. Of those, therapeutic compliance was good in 24 patients (55.8%), and it was irregular in 13 patients. Thus, the overall compliance rate for patients with latent tuberculosis infection was 77.8%. Among the 28 patients receiving primary chemoprophylaxis, therapeutic compliance wasgood in 15 patients, and irregular in 8 patients. Conclusions. 1) A good therapeutic compliance is very important to decrease the prevalence of tuberculois. The best method to improve compliance is direct supervision, which is not always feasible. 2) The compliance rates in our population (81.25% and 77.8%) are satisfactory, but could be improved. 3) The methodology used in our study is not optimal, but it is harmless, cheap and easy to perform. 4) It is essential that the primary pediatrician educates the patients on the severity of the disease and the importance of a good therapeutic compliance. 5) A stable health-care team facilitates the therapeutic compliance. 6) Short regimens are associated with better compliance (AU)