NICE, the National Institute for Health and Care Excellence, has updated its tuberculosis (TB) guidance.
Despite a reduction in the number of TB cases in the past three years, England is still has the highest number of cases in Western Europe. There were 6,523 TB cases in England in 2014. London reported over 39% (2,572) of the country’s total, with a rate of around 30 TB cases per 100,000 people.
Effective management of TB is dependent on close working between hospital, community and voluntary organisations. To recognise this, the new NICE guidance combines clinical advice and public health guidance for the first time.
The new guideline focuses on prevention and education.
- Searching out active cases in the communities most at risk (areas where homelessness, drug use and poverty are prevalent).
- Treatment of latent TB is extended from people aged 35 years-and-under to 65 years-and-under. A course of medication for latent TB is shorter, easier to stick to and cheaper than the subsequent treatment required should the disease become active and infectious.
- Education and awareness should be a key priority. Those with TB should be supported in their treatment to avoid drug resistance and limit the spread of the disease.
Dr Noel Baxter, GP, clinical commissioner and PCRS-UK Chair Elect, said: “This guidance reinforces current approaches for primary care clinicians working in areas with high risk patients and is a useful reminder of best practice. Disappointingly, NICE has failed to highlight the impact of smoking tobacco on TB and that this is something primary care professionals interested in respiratory health could help with.”
A recent study in The International Journal of Tuberculosis and Lung Disease showed that regular tobacco smoking doubles the risk that people who have been successfully treated for TB will develop TB again—a condition known as "recurrent" TB. The study is the most robust ever conducted into how smoking tobacco increases the risk of recurrent TB.
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