Drug-Susceptible Tuberculosis
Key Points
Key Points
- Treatment of tuberculosis is focused on both curing the individual patient and minimizing the transmission of Mycobacterium tuberculosis to other persons.
- The objectives of tuberculosis therapy are:
- to rapidly reduce the number of actively growing bacilli in the patient, thereby decreasing severity of the disease, preventing death and halting transmission of M. tuberculosis
- to eradicate populations of persisting bacilli in order to achieve durable cure (prevent relapse) after completion of therapy
- to prevent acquisition of drug resistance during therapy.
- Given the public health implications of prompt diagnosis and effective management of tuberculosis, empiric multidrug treatment is initiated in almost all situations in which active tuberculosis is suspected.
- Tuberculosis treatment requires multiple drugs be given for several months, and as such it is crucial that the patient be involved in a meaningful way in making decisions concerning treatment supervision and overall care, including decisions around the use of directly observed therapy (DOT), which remains the standard of practice in the majority of tuberculosis programs in the United States and Europe.
- The preferred regimen for treating adults with tuberculosis caused by organisms that are not known or suspected to be drug resistant is a regimen consisting of an intensive phase of 2 months of isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB) followed by a continuation phase of 4 months of INH and RIF.
- With respect to administration schedule, the preferred frequency is once daily for both the intensive and continuation phases. Nonetheless, on the basis of substantial clinical experience, experts believe that 5-days-a-week drug administration by DOT is an acceptable alternative to 7-days-a-week administration, and either approach may be considered as meeting the definition of “daily” dosing.
Assessment
Assessme...
...actors to be Considered in Deciding to...
Treatment
Treatme...
Organization and Supervision of Treatment
...Recommendation Grad...
Recommendation 1: The panel suggests using ca...
...ation 2: The panel suggests using DOT ra...
...ed Treatment Regimens...
...3a: The panel recommends the use of da...
...ndation 3b: Use of thrice-weekly therapy in...
...n 3c: In situations where daily or thrice...
...a: The panel recommends the use of dai...
...dation 4b: If intermittent therapy is t...
...ion 4c: The panel recommends against IN...
...reatment in Special Situati...
...commendation 5a: For HIV-infected patients receiv...
...ecommendation 5b: In uncommon situations in w...
...dation 6: The panel recommends initiating ART...
...lmonary Tuberculosis...
...on 7: The panel suggests initial adjunctiv...
...mendation 8: The panel recommends initial adjunct...
...Pulmonary Tuberculosis in Adults...
...dation 9: The panel suggests that a 4-mon...
...g Regimens for Microbiologically Confirmed Pulmon...
...esa of Antituberculosis Drugs for Adults and Child...
...able 3. Possible Components of a Multifa...
...able 4. Examples of Priority Situations for the...
...line And Follow-Up Evaluations For Patien...
...able 5. Management of Treatment Inte...
Table 6. Other Causes of Abnormal Liver Function T...
...Conditions or Situations in Which Therapeu...
...8. Clinically Significant Drug–Drug Interactions...
...ted Pyrazinamide Doses, Using Whole Tablet...
...gested Ethambutol Dosages, Using Whol...
...g Recommendations for Adult Patients With Redu...