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Editor,—We read with interest the recent paper on the management of tuberculosis in Wales.1 Almost a decade later, similar concerns led to a specialist paediatric TB service being established in 1995 at the Royal Hospital for Sick Children in Glasgow (RHSC). Key components have been the involvement of a few experienced staff, close liaison with community TB liaison health visitors, a computerised information management system, and the development of local guidelines based on those recommended by the British Thoracic Society (BTS).2 A recent audit was conducted. The results provide an interesting comparison to that published from Wales (table1).
The two patient groups are very similar. Many of the deficiencies highlighted in the Welsh audit have been addressed, at least partially, within the context of a specialist paediatric service. Documentation and notification of cases were better. Bacteriological confirmation of tuberculosis was attempted in virtually all of our patients and achieved in 35% of children, comparing favourably with both the Welsh audit and a recent study from South Africa.3 More children treated at the specialist clinic received and completed appropriate treatment, as specified in the BTS guideline.2
We believe that some of the advantages of the specialist paediatric TB service are worth highlighting and could be adapted to more general settings:
The BTS guidelines2 emphasise that TB in children should be managed between thoracic physicians and paediatricians. TB liaison nurses with direct access to the clinic staff are a vital link allowing good communication between the two services
A specialist service with agreed protocols encourages uniformity of treatment. It enables expertise to develop and provides excellent training for both medical and nursing staff
A multidisciplinary approach enables non-compliance and poor clinic attendance to be rapidly addressed. Directly observed treatment can be implemented quickly if necessary
A computerised management system encourages better documentation. It also facilitates audit and research, and most importantly tight quality control.
The Welsh study showed that very few children were managed appropriately. The specialist service in our hospital has successfully attempted to improve this. However, such a service is not a panacea. With rising numbers of adults with TB, continuing vigilance among paediatricians is essential. The new paediatric TB guidelines will be an important step but continued audit and monitoring will remain vital.