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Tuberculosis in Siberia: 2. Diagnosis, chemoprophylaxis and treatment
F Drobniewski1, E Tayler, N Ignatenko
1Regional Tuberculosis Centre, Dulwich Public Health Laboratory, London, UK.
Objective:
To assess tuberculosis diagnosis, chemoprophylaxis and therapy in Siberia as a paradigm for the Russian Federation.
Design:
Data was obtained from official sources and through visits to dispensaries and hospitals in 1994.
Results:
Tuberculosis disease and cure is classified according to a Dispensary Group Register based principally on clinical and radiological criteria. Isoniazid is widely used for chemoprophylaxis and post-therapy and may be linked to high levels of isoniazid resistance. Combination drug therapy is individualized, frequently changed, and given orally, parenterally or intra-bronchially. Galvanization, autotransfusion of ultra-violet irradiated blood, antioxidants and steroids are used as adjunct treatment. Ambulatory treatment is uncommon. Surgical treatments including lobectomy and pneumonectomy are used in 5-10% of patients.
Conclusion:
Tuberculosis is increasing in Siberia. An improved drug supply using short course standardized regimens is required supported by high quality co-ordinated bacteriological services. Surgery retains a useful role, but many adjunct therapies should be abandoned.