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
...essment...
...e 1. Factors to be Considered in Deciding to I...
Treatment
...reatment
...nization and Supervision of Treatment...
...e Recommendation Gra...
...commendation 1: The panel suggests using case ma...
...ion 2: The panel suggests using DOT rat...
...d Treatment Regimens...
...n 3a: The panel recommends the use of...
...endation 3b: Use of thrice-weekly therapy...
Recommendation 3c: In situations where daily or...
...ion 4a: The panel recommends the use of daily or...
...on 4b: If intermittent therapy is to be administer...
...c: The panel recommends against INH 900 mg...
...ent in Special Situations...
...tion 5a: For HIV-infected patients rec...
...on 5b: In uncommon situations in which...
...dation 6: The panel recommends initiating A...
...lmonary Tuberculosis...
...endation 7: The panel suggests initial adjuncti...
...8: The panel recommends initial adj...
...gative Pulmonary Tuberculosis in Adults...
...n 9: The panel suggests that a 4-month...
Table 1. Drug Regimens for Microbiologically...
...Dosesa of Antituberculosis Drugs for Adults a...
...le 3. Possible Components of a Multif...
.... Examples of Priority Situations for the Use...
...Baseline And Follow-Up Evaluations For P...
...able 5. Management of Treatment Interrupti...
...ble 6. Other Causes of Abnormal Liver Func...
...ons or Situations in Which Therapeutic Drug...
...le 8. Clinically Significant Drug–Drug Interac...
...Suggested Pyrazinamide Doses, Using Whole Tabl...
...Suggested Ethambutol Dosages, Using Whole Tab...
...Recommendations for Adult Patients Wi...