Early versus delayed treatment of TB
Two prospective cohort studies of poor quality reported that a delay in time to diagnosis, defined as the period from onset of any TB symptoms to the diagnosis of TB, was significantly associated with an increased risk of transmission of infection among contacts. A retrospective cohort study of poor quality, conducted in New Zealand, indicated that the time between development of symptoms and diagnosis was not significantly associated with the odds of achieving a favourable treatment outcome (i.e. cure or treatment completed).
Early identification of drug resistance
No studies were identified that met the PICO criteria. However, three cohort studies (two retrospective) of medium quality provided some evidence that patients with rifampicin-resistant TB who received a rifampicin-containing Category II treatment, before receiving the results of drug sensitivity testing, had slightly poorer health outcomes than those who did not.
Unnecessary antibiotic treatment
All TB patients are at risk of adverse health events (e.g. hepatitis) associated with first-line treatment. Two SRs, one of medium quality and one of poor quality, found that some but not all AEs as a consequence of patients with active TB receiving inappropriate antibiotic treatment (due to MTB resistance) may be avoided with appropriate treatment, to which the MTB strain is sensitive. One SR of good quality found that patients have a higher risk of developing multidrug-resistant TB (MDR-TB) if they receive inappropriate drug treatment.
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