Practice Guidelines

Tuberculosis—diagnosis, management, prevention, and control: summary of updated NICE guidance

BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.h6747 (Published 13 January 2016) Cite this as: BMJ 2016;352:h6747
  1. Lucy Elizabeth Hoppe, technical analyst (clinical)1,
  2. Rachel Kettle, technical advisor (public health)2,
  3. Michael Eisenhut, consultant paediatrician and member of the Guideline Development Group3,
  4. Ibrahim Abubakar, professor of infectious disease epidemiology and co-chair of the Guideline Development Group4
  5. on behalf of the Guideline Development Group
  1. 1National Institute for Health and Care Excellence, London SW1A 2BU, UK
  2. 2National Institute for Health and Care Excellence, Manchester M1 4BT
  3. 3Luton & Dunstable University Hospital NHS Foundation Trust, Luton, Bedford LU4 0DZ
  4. 4MRC Clinical Trials Unit at UCL and Centre for Infectious Disease Epidemiology, University College London, London WC1E 6BT
  1. Correspondence to: L E Hoppe lucy.hoppe{at}nice.org.uk

What you need to know

  • Undertake tuberculosis (TB) testing in close contacts of people with pulmonary or laryngeal TB, people who are immunocompromised and at high risk of TB, and new entrants from high incidence countries who present to healthcare services

  • Seek specialist input in the diagnosis and management of TB in children, and in the management of people with multidrug resistant TB or those with TB and comorbidities

  • Consider enhanced case management, including directly observed therapy (DOT), in patients with clinically or socially complex needs

  • Apply appropriate infection control measures if a person has suspected or confirmed infectious TB (pulmonary or laryngeal TB)

Tuberculosis (TB) incidence in the UK remains high compared with other Western European countries.1 It disproportionately affects underserved groups, including homeless people, people in poor housing or affected by poverty, people with problem drug use, and people born in countries with a high incidence of TB.2 However, many cases are preventable with public health measures, and, when disease does occur, most people can be cured. This article summarises the updated recommendations on diagnosing, managing, and preventing TB from the National Institute for Health and Care Excellence (NICE).1 This guidance updates the 2011 clinical guideline3 and incorporates the public health guidance on the identification and management of TB in under-served groups.4

What’s new in this guidance

  • Increase in the upper age limit for testing and treatment for latent TB from 35 years to 65 years

  • A Mantoux test is considered positive at an induration of ≥5 mm regardless of BCG history

  • How to re-establish treatment for active or latent TB after interruptions by adverse events from drug treatment

Recommendations

NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of …

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