curves. Cumulative TB rates were expressed as time after UK entry and time after GP registration and compared between immigrant subgroups stratified by WHO incidence in country of origin (150e499/100 000 or 500+/100 000) and age group at time of registration (<16, 16e35 or ¼36 years). The number needed to screen was calculated using an overall prevalence estimate of 25% IGRA positivity, with all cases occurring in this subgroup. Results 564 cases were recorded in 34 764 immigrants. The median (IQR) observation was 2198 (982e3329) days after UK entry and 956 (358e1888) days after GP registration. There was no difference in risk with time after UK entry or GP registration and the TB rate rose linearly over 10 years. In our cohort, the 5-year cumulative TB rate was significantly higher for immigrants from regions with incidence of 150e499 than those from 500+. The TB rate was also significantly higher in adults than children, and highest in adults aged 16e35 years (Abstract P55

Introduction and Objectives Multi-drug resistant tuberculosis (MDR-TB) is a growing concern 1. Cost of treatment is ten times that of fully sensitive TB. Treatment regimens are complex and prolonged with risk of serious adverse drug reactions (ADRs). Previously no single guidance in the UK has been available to inform clinicians on what baseline testing should be performed and how to monitor for ADRs 2. We would like to introduce the first UK guideline for adverse-effect monitoring in MDR-TB. Methods This document has been written using the best available evidence and, where this is limited, expert consensus. Our multidisciplinary guideline group held regular teleconferences and corresponded by email. When evidence was sparse, expert consensus was sought from the British Thoracic Society TB Special Advisory Group (SAG) and UK MDR-TB Advisory Service. When other specialty input was needed this was sought from experts in that field. Once the guideline was developed it was submitted to the TB SAG for peer review. Results 'MDR-TB: A guideline for treatment monitoring' includes direction on baseline and generic monitoring throughout treatment and individual drug monographs for all drugs currently used to treat MDR-TB in the UK. At the time of writing it is due to be published online, later this month, and will be available on the BTS website (www.brit-thoracic.org.uk). Conclusions We hope that by introducing a guideline to aid ADR monitoring in MDR-TB treatment we can improve morbidity and mortality and reduce treatment costs. By the time of the BTS Winter Meeting we will have nearly six months experience of this guideline being used in practice and will present any feedback received. In due course we plan to audit its use and publish our experiences.