Impact of empiric antibiotics and chest radiograph on delays in the diagnosis of tuberculosis

Int J Tuberc Lung Dis. 2005 Apr;9(4):392-7.


Setting: Maryland Department of Health and Mental Hygiene, Division of Tuberculosis (TB) Control.

Objectives: To 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.

Design: A nested case-control study within a prospective study conducted to assess factors associated with delays in the diagnosis of TB.

Results: Cases (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.

Conclusion: More widespread use of CXR when diagnosing CAP should reduce delays in diagnosing TB, and the unnecessary use of antibiotics.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Anti-Bacterial Agents / therapeutic use*
  • Case-Control Studies
  • Community-Acquired Infections / diagnosis
  • Community-Acquired Infections / drug therapy
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pneumonia / diagnosis
  • Pneumonia / drug therapy
  • Radiography, Thoracic*
  • Time Factors
  • Tuberculosis, Pulmonary / diagnosis*


  • Anti-Bacterial Agents