The Use Of Evidence Based Medicine In Prevention And Treatment Of Tuberculosis

Objectives: In order to understand if evidence based medicinemethodology could effectively used in prevention and treatment oftuberculosis, we conducted the following three studies:(1) the associationbetween TNFA and tuberculosis susceptibility;(2) the effectiveness andsecurity of levofloxacin on controlling Multi-drug resistant Tuberculosis;(3)the effectiveness of treatment outcomes of global PPM programmes.Methods: We carried out standard methodology, including inclusioncriteria, selection process, data extraction and quality assessment. Then, wecompared and summarized the methodology used in three studies.Moreover, we detected the quality of evidence in all parts by using GRADEstandard.Results:1. TNFA gene polymorphisms and TB susceptibility: A totalnumber of twenty-three case-control studies including3630cases and4055controls. No association was found between308G>A,863C>A and TBsusceptibility. Increased risk of TB was associated with857C>T indominant genetic model, heterozygote comparison and homozygotecomparison in Asian subjects.2. The effectiveness of levofloxacin oncontrolling Multi-drug resistant Tuberculosis: A total number of31RCTswere included. Meta-analysis revealed that,(1) Compared with blankcontrolled group, Ofloxacin, as well as Ethambutol/Streptomycin,levofloxacin probably increases the sputum negative conversion rates after3months and at the end of the treatment period;(2) Compared withlevofloxacin, Gatifloxacin and Moxifloxacin probably increase the sputum negative conversion rates after3months and at the end of the treatmentperiod;(3) There is not any significant statistical difference of adversereaction rates between each of the medication regimens (P=0.19).3. Theeffectiveness of treatment outcomes of global PPM programmes: A total ofeligible69studies were finally included in systematic review whichcontained a total number of43PPM TB programs all over the world and7publication were included in meta-analysis, consisting of8datasets. Wequantitatively assessed the effectiveness of treatment results of PPMprograms. The results of meta-analysis suggested that the successfullytreated rate, interrupted rate, failed rate and died rate were not statisticallydifferent in PPM group and non-PPM group. However, the transferred outrate was lower in PPM group compared with non-PPM group. Nopublication bias was found.4. The assessment of Evidence BasedMedicine used in study: We compared the different original study designs,qualitative and quantitative systematic reviews and different softwares inorder to understand the advantages and drawbacks of the three systematicreviews. After grading the evidence level in each part, we discovered thatthe evidence collected from the first part should be ranked as D level andthat got from the second and third part was classified from level B to D.Conclusion:1. There are standard evidence based methodology whichcould be applied for testing the gene polymorphisms and TB susceptibility.However, due to observational studies, the level of evidence is low.2.Methods used for pooling the results of RCTs are quite commonly used,and the level of quality is usually high. However, domestic RCTs usuallysuffered from low quality, and thus, the level of evidence is declined.3. Inthe area of tuberculosis management, we witnessed some drawbacks ofevidence based medicine methodology. For instance, there is no standardquality assessment for some certain kinds of observational studies. Moreover, the consequences of research could be easily affected by biases.4. There are some advantages and disadvantages in all three systematicreviews. The quality of original studies should be strengthened in order toincrease the quantity of evidence level.