The management of lymph node tuberculosis notified in England and Wales in 1993

We have compared the management of 219 cases of lymph node tuberculosis reported to the 1993 national notification survey with the recommended standards of treatment. The diagnosis was supported by positive histology and bacteriology in 81 cases (37%), positive histology in 70 (32%), positive bacteriology in 26 (12%), and on only clinical grounds in 40 (18%). Most patients (88%) were under the care of thoracic physicians. Almost all (97%) were commenced on a recommended drug combination, but only 81% continued to receive it, with thoracic physicians more likely than other physicians to use a recommended combination. Non-standard durations of the initial and/or continuation phases of treatment were used in 83 patients, but in only 49 cases was a satisfactory reason given for the modification. Definite or suspected drug toxicity was reported in 22 cases (10%), and was significantly more likely with non-standard regimens. There were no deaths. Of the 209 patients observed to treatment completion, 129 (62%) were then discharged. There were adequate reasons for follow-up after the end of treatment in all but 32 (15%) of those so managed. Further education is required to increase the percentage of patients treated with evidence-based regimens and durations of chemotherapy.