The Effect of Empiric Initiation of Treatment on Outcomes among Patients Presenting with Extrapulmonary Mycobacterium tuberculosis Infection in a Community Hospital Setting

Authors

• Talha Awwal, Department of Medicine, University of Illinois College of Medicine, Peoria, IL, USA
• Faisal Raja Kh, American University of Barbados, Barbados
• Hanya Awaba, Foundation University Medical College, Rawalpindi, Pakistan
• Waseem Anwar, Shaukat Khanum Cancer Institute, Lahore, Pakistan
• Jinma Ren, Center for Outcomes Research, University of Illinois College of Medicine, Peoria, IL, USA
• Muhammad Aamir Safdar, National TB Control Program, Ministry of Health Services, Government of Pakistan, Pakistan
• Saqib Walayat, Department of Medicine, University of Illinois College of Medicine, Peoria, IL, USAFollow
• John J. Farrell, Department of Medicine, University of Illinois College of Medicine, Peoria, IL, USA

Abstract

Background: Extrapulmonary tuberculosis (EPTB) accounts for ~20% of Mycobacterium tuberculosis infections in Pakistan. Diagnostic delays are common and may worsen outcomes. We evaluated whether empiric treatment initiation improves outcomes among patients with EPTB at a large public hospital in Islamabad, Pakistan. Methods: Retrospective cohort of consecutive EPTB cases at Pakistan Institute of Medical Sciences (January–June 2016). Patients were categorized as clinically diagnosed (symptoms/radiology) or laboratory-supported (histology, microbiology, or biochemical tests). Standard Directly Observed Therapy Short-course (DOTS) based regimens were used. Outcomes were treatment success, failure, loss to follow-up, and mortality; groups were compared using chi-square testing. Results: Of 317 EPTB patients, 275 completed treatment and were analyzed. Mean age was 34.4 years; 57% were male. The most common sites were pleural (28.7%) and lymphatic (20.3%) TB. Clinically diagnosed patients had higher cure rates than laboratory supported diagnosis group patients (87.6% vs. 79.6%; p=0.221) and significantly lower mortality (5.3% vs. 9.3%; p=0.041). Among patients who completed treatment, 82.9% achieved treatment success; overall cure rate was 71% including non-completion and loss to follow-up. Conclusions: Early empiric therapy may be  associated with improved survival and higher cure rates compared with delaying treatment pending laboratory confirmation. Context-appropriate EPTB guidelines emphasizing prompt clinical treatment are warranted in high burden settings.

Recommended Citation

Awwal, Talha; Raja Kh, Faisal; Awaba, Hanya; Anwar, Waseem; Ren, Jinma; Safdar, Muhammad Aamir; Walayat, Saqib; and Farrell, John J. (2026) "The Effect of Empiric Initiation of Treatment on Outcomes among Patients Presenting with Extrapulmonary Mycobacterium tuberculosis Infection in a Community Hospital Setting," Journal of Community Hospital Internal Medicine Perspectives: Vol. 16: Iss. 4, Article 7.
DOI: https://doi.org/10.55729/2000-9666.1623
Available at: https://scholarlycommons.gbmc.org/jchimp/vol16/iss4/7

DOI

10.55729/2000-9666.1623