Treatment of new pulmonary tuberculosis patients: what do allopathic doctors do in India?

SETTING: Out- and in-patient services of the Department of Tuberculosis and Chest Diseases at King George's Medical College, Lucknow, India. OBJECTIVE: To analyse the prescribing patterns of allopathic doctors for treatment of new cases of pulmonary tuberculosis (PTB), and to compare their practices with the current national and World Health Organization (WHO) recommendations. DESIGN: A consecutive case series. Tuberculosis treatment practices of 449 primary doctors who had prescribed treatment for PTB to 218 patients were analysed. RESULTS: Thirty-three different drug combination regimens were prescribed by 449 primary doctors. Approximately 45% (95%CI 41.5-49.9) of doctors did not practise the current NTP/WHO recommended drug regimens. Overall 75% (95%C1 70.4-78.8) of doctors made prescription errors with respect to one or more aspects of treatment, including treatment duration (64.5%) and drug dosages (30%). The most frequent prescription error was treatment for longer than necessary (60.2%; 95%CI 55.5-64.8). Overall, both chest specialists and non-chest specialists made prescription errors with almost equal frequency (77.5% vs. 72.2%, P = 0.228). The majority of the doctors (70.2%; 95%CI 65.7-74.5) used fixed-dose formulations of two to four drugs. CONCLUSION: For effective tuberculosis control, strategies for targeted continuing medical education and auditing of the practices of all doctors need to be implemented without delay.