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Does exposure to fluoroquinolone antibiotics delay diagnosis of pulmonary tuberculosis? Wang, Yi Qing

Abstract

Tuberculosis (TB) remains a major public health concern, and a delay in its diagnosis leads to continued disease transmission, and at the population level, may result in ineffective TB control programs. This delay may be associated with the inappropriate use of antibiotics, particularly the respiratory fluoroquinolones (FQ). In our study we determined whether the use of fluoroquinolones and other antibiotics results in a delay in the diagnosis of TB. We used population-based data from the British Columbia Linked Health Databases (BCLHD), which collects longitudinal health care information. Residents who had active pulmonary TB from January 1, 1997 to December 31, 2006 as identified through the provincial TB control database were included and linked with data in BCLHD. Negative binomial regression was used to calculate the relative risk (RR) of health care delay (the time between first patient contact with the health care system for a respiratory condition and the initiation of anti-TB medication) and antibiotic delay (the time between first patient prescription fill for antibiotics and initiation of anti-TB medication) compared to controls, adjusting for potential confounders. A total of 2232 patients had active TB diagnosed in BC between 1997 and 2006. Of these, 1544 participants were included in the study with health care contact six months prior to the date of diagnosis. After adjusting for gender, age, foreign-born status, socioeconomic status, prior chest radiograph and physician specialist visit, the health care delay for patients exposed to antibiotics was found to be significant at RR 2.10 (95% CI 1.80-2.44). Gender, age, foreign-born status and socioeconomic status were not found to be significant factors. When categorizing this delay by antibiotic type, all antibiotic categories were at a significantly increased risk for delay. In addition, this delay increased as the antibiotics prescribed also increased for the patient. Delay related to antibiotic exposure was found to be significant for the combination of FQ and non-FQ antibiotics at RR 1.35 (95% CI 1.08-1.70), but not for the FQ or non-FQ only categories. Our results indicate a delay in TB diagnosis due to previous exposure to any antibiotic and not just fluoroquinolones.

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