• J E Golub, S Bur, W A Cronin, S Gange, T R Sterling, B Oden, N Baruch, G W Comstock, and R E Chaisson.
• School of Medicine, Johns Hopkins University, Baltimore, Maryland 21231, USA. jgolub@jhmi.edu
• Int. J. Tuberc. Lung Dis. 2005 Apr 1; 9 (4): 392-7.

SettingMaryland Department of Health and Mental Hygiene, Division of Tuberculosis (TB) Control.ObjectivesTo assess the implications of antibiotic treatment of presumed community-acquired pneumonia (CAP) on delays in the diagnosis of TB, and to assess the frequency with which chest radiographs (CXRs) were utilized before a diagnosis of pneumonia or pulmonary TB was made.DesignA nested case-control study within a prospective study conducted to assess factors associated with delays in the diagnosis of TB.ResultsCases (n = 85; 54%) were patients who received antibiotics for non-TB diagnoses/indications prior to TB diagnosis, and controls (n = 73; 46%) were patients who had initially received TB therapy. Median health care delay for cases was 39 days vs. 15 days (P < 0.01) for controls. Median antibiotic delay was similar among all antibiotic classes. Of 54 patients who did not have a CXR at their first health care visit, 41 (79%) received empiric antibiotics, compared to 44/105 (42%) who had a CXR (P < 0.01). Only 31/54 (57%) patients initially diagnosed with CAP had a CXR at the time of diagnosis.ConclusionMore widespread use of CXR when diagnosing CAP should reduce delays in diagnosing TB, and the unnecessary use of antibiotics.

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