Nice | Tuberculosis

This is quite a complex, meaty guideline, with lots of flow-charts. Remember to consider if a newly registering patient should be screened and remember BCG in neonates at risk, but otherwise I would suggest referring to the guideline if a specific situation arises.

However, the main new things here are:

  • At registration of a new patient, consider if screening may be appropriate.
  • What screening is done, will be dependent on the age of the patient and the exposure or the situation, so check the guideline for specifics.
  • Any screened people who are not infected and haven’t had a BCG, should be given it if they are at high risk (eg country with incidence of 500 per 100,000 OR sub-saharan Africa) AND are younger than 35. You can have a lower threshold for vaccinating under 16s (it just says ‘high risk’ countries without qualifying this).
  • If you are concerned about a possible diagnosis, do a CXR and at least 3 sputum samples (including an early morning one).

Louise Hudman

I'm a freelance GP locum in Winchester & Southampton locum chambers, and Pallant Medical Chambers Clinical Guidelines Lead Partner.

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