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Ambulatory care versus isolation care of ( MDR) TB

By Iris de Ridder | 23 Oct, 2015

I have a question on (mdr) tb infection control.
I am a doctor in png, currently a big (mdr) TB hotspot.
Some organizations in the country are setting up an mdr treatment program with 100% ambulatory care of ( mdr) tb patients. Regardless if they are sputum positive or not, or MDR or not. They are Sending them home to live with their families with health education to sleep in seperate rooms with ventilation. ( difficult in png) .In our hospital we are currently still isolating the sputum positive ones untill they are sputum negative. Which in my opinion makes more sense infection control wise. I was just wondering what your opions are and if there is any research/ evidence for full ambulatory care versus isolation care.

Iris de ridder



Catherine Berry Replied at 4:53 PM, 26 Oct 2015

Great question.
I can give you a long reply about the evidence for this but its well presented in several avenues including elsewhere on this forum. Ed Nardell's lectures on infection control here: summarise it well.
Good luck.

Best regards,

Masoud Dara, MD Moderator Replied at 8:35 AM, 27 Oct 2015

Dear Iris,

The priority is to start an adequate treatment as soon as possible. Treatment can be initiated on an ambulatory basis. The arguments are that patients have often infected their close family members (they are living with) by the time they are diagnosed. Having said that, extra caution is needed to avoid any further transmission. In addition, it is very important to provide necessary check-up to look for and manage adverse events.

Alan Adler Replied at 11:23 AM, 27 Oct 2015

I agree that if feasible, that is, if the patient is stable, ambulatory care is preferable. Reasons to be in the hospital are an unstable or unsafe living situation and of course issues of compliance even with directly observed therapy

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