Tuberculosis in Siberia .2. Diagnosis, chemoprophylaxis and treatment

Objective: To assess tuberculosis diagnosis, chemoprophylaxis and therapy in Siberia as a paradigm for the Russian Federation. Design: Data was obtained from official sources and through visits to dispensaries and hospitals in 1994. Results: Tuberculosis disease and cure is classified according to a Dispensary Group Register based principally on clinical and radiological criteria, Isoniazid is widely used for chemoprophylaxis and post-therapy and may be linked to high levels of isoniazid resistance, Combination drug therapy is individualized, frequently changed, and given orally, parenterally or intra-bronchially. Galvanization, autotransfusion of ultra-violet irradiated blood, antioxidants and steroids are used as adjunct treatment, Ambulatory treatment is uncommon, Surgical treatments including lobectomy and pneumonectomy are used in 5-10% of patients. Conclusion: Tuberculosis is increasing in Siberia. An improved drug supply using short course standardized regimens is required supported by high quality co-ordinated bacteriological services, Surgery retains a useful role, but many adjunct therapies should be abandoned.