Prescription practice of anti-tuberculosis drugs in Yunnan, China: A clinical audit

PLoS One. 2017 Oct 31;12(10):e0187076. doi: 10.1371/journal.pone.0187076. eCollection 2017.

Abstract

Objectives: China has a high burden of drug-resistant tuberculosis (TB). As irrational use and inadequate dosing of anti-TB drugs may contribute to the epidemic of drug-resistant TB, we assessed the drug types and dosages prescribed in the treatment of TB cases in a representative sample of health care facilities in Yunnan.

Methods: We applied multistage cluster sampling using probability proportion to size to select 28 counties in Yunnan. Consecutive pulmonary TB patients were enrolled from either the TB centers of Yunnan Center of Disease Control or designated TB hospitals. Outcomes of interest included the regimen used in the treatment of new and retreatment TB patients; and the proportion of patients treated with adequate dosing of anti-TB drugs. Furthermore, we assess whether there has been reduction in the use of fluoroquinolone and second line injectables in Tuberculosis Clinical Centre (TCC) after the training activity in late 2012.

Results: Of 2390 TB patients enrolled, 582 (24.4%) were prescribed second line anti-TB drugs (18.0% in new cases and 60.9% in retreatment cases); 363(15.2%) prescribed a fluoroquinolone. General hospitals (adjusted odds ratio (adjOR) 1.97, 95% confidence interval (CI) 1.47-2.66), retreatment TB cases (adjOR 4.75, 95% CI 3.59-6.27), smear positive cases (adjOR 1.69, 95% CI 1.22-2.33), and extrapulmonary TB (adjOR 2.59, 95% CI 1.66-4.03) were significantly associated with the use of fluoroquinolones. The proportion of patients treated with fluoroquinolones decreased from 41.4% before 2013 to 13.5% after 2013 (adjOR 0.19, 95% CI 0.12-0.28) in TCC. The proportion of patients with correct, under and over dosages of isoniazid was 88.2%, 1.5%, and 10.4%, respectively; of rifampicin was 50.2%, 46.8%, and 2.9%; of pyrazinamide was 67.6%, 31.7% and 0.7%; and of ethambutol was 41.4%, 57.5%, and 1.0%.

Conclusions: The prescribing practice of anti-TB drugs was not standardized, findings with significant programmatic implication.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Antitubercular Agents / therapeutic use*
  • Asian People
  • China
  • Clinical Audit / methods
  • Clinical Audit / statistics & numerical data*
  • Ethambutol / therapeutic use
  • Female
  • Fluoroquinolones / therapeutic use
  • Humans
  • Isoniazid / therapeutic use
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care / methods
  • Outcome Assessment, Health Care / statistics & numerical data
  • Prescriptions / standards
  • Prescriptions / statistics & numerical data*
  • Pyrazinamide / therapeutic use
  • Retreatment / statistics & numerical data
  • Rifampin / therapeutic use
  • Tuberculosis, Multidrug-Resistant / drug therapy*
  • Tuberculosis, Multidrug-Resistant / ethnology
  • Tuberculosis, Pulmonary / drug therapy
  • Tuberculosis, Pulmonary / ethnology

Substances

  • Antitubercular Agents
  • Fluoroquinolones
  • Pyrazinamide
  • Ethambutol
  • Isoniazid
  • Rifampin

Grants and funding

This work was funded by the Yunnan Provincial Health Bureau and the United States Agency for International Development (USAID). Funding from the Yunnan Provincial Health Bureau was provided through the Yunnan Provincial Center for Tuberculosis Research. Funding from USAID was provided through Cooperative Agreement No. AID-486-A-12-00002, titled "Greater Mekong Sub-region Multidrug Resistant Tuberculosis Prevention and Management" and implemented by FHI 360. Views expressed do not necessarily represent the those of USAID or FHI 360. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.