Consensus Guidelines for Initiating Anti-Tubercular Therapy in Tubercular Choroiditis
Purpose
The diagnosis and management of tubercular uveitis poses significant conundrums. Current guidelines and literature are insufficient to guide physicians regarding the administration of anti-tubercular therapy (ATT). An international, expert-led consensus initiative by the Collaborative Ocular Tuberculosis Study (COTS) group developed evidence- and experience-based recommendations for the treatment of tubercular choroiditis.
Methods
An international expert steering subcommittee of COTS group identified clinical questions and conducted a systematic review of the published literature on the use of ATT for tubercular choroiditis. Using a smart online questionnaire, 81 global experts generated preliminary consensus statements for initiating ATT in tubercular choroiditis, utilizing Oxford levels of medicine evidence. COTS group members met in November 2018 to refine these consensus statements by a two-step modified Delphi process.
Results
162 clinical scenarios were identified around when to initiate ATT in tubercular serpiginous-like choroiditis, tuberculoma and tubercular focal or multifocal choroiditis. Seventy consensus statements addressed the initiation of ATT and 12 on the use of adjunctive therapies in tubercular choroiditis were developed.
Conclusion
Consensus guidelines were developed to guide the initiation of ATT in tubercular choroiditis, based on literature, expert opinion and practical experience, to bridge the gap between clinical need and medical evidence.
Conflict of interest
No
Author 1
Last name
TESTI
Initials of first name(s)
I
City
Padova
Country
Italy
Author 2
Last name
Agrawal
Initials of first name(s)
R
City
Singapore
Country
Singapore
Author 3
Last name
Mahajan
Initials of first name(s)
S
City
Stanford
Country
United States
Author 4
Last name
Agarwal
Initials of first name(s)
A
City
Chandigarh
Country
India
Author 5
Last name
Kempen
Initials of first name(s)
JH
City
Boston
Country
United States
Author 6
Last name
Douglas
Initials of first name(s)
AJ
City
Baltimore
Country
United States
Author 7
Last name
Smith
Initials of first name(s)
JR
City
Adelaide
Country
Australia
Author 8
Last name
Nguyen
Initials of first name(s)
QD
City
Stanford
Country
United States
Author 9
Last name
Pavesio
Initials of first name(s)
C
City
Chandigarh
Country
India
Author 10
Last name
Gupta
Initials of first name(s)
V
City
Chandigarh
Country
India
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