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
...Assessment...
...1. Factors to be Considered in Deciding to Initia...
Treatment
...Or...
...commendation Grading....
...commendation 1: The panel suggests u...
...ion 2: The panel suggests using DOT r...
...Recommended Treatment...
...3a: The panel recommends the use of d...
...on 3b: Use of thrice-weekly therapy in the inten...
...ndation 3c: In situations where daily or thrice-we...
Recommendation 4a: The panel recommends t...
...ndation 4b: If intermittent therapy is...
Recommendation 4c: The panel recomm...
...Treatment in Special Situa...
...ommendation 5a: For HIV-infected patients receivi...
...commendation 5b: In uncommon situation...
...: The panel recommends initiating ART during t...
...Extrapulmonary T...
...mmendation 7: The panel suggests initial adjun...
...n 8: The panel recommends initial adjunct...
...Culture-Negative...
...mmendation 9: The panel suggests that a 4-month...
.... Drug Regimens for Microbiological...
...ble 2. Dosesa of Antituberculosis Drugs for Adults...
...3. Possible Components of a Multifaceted, Patien...
...les of Priority Situations for the Use of Directly...
...Baseline And Follow-Up Evaluations...
...anagement of Treatment Interruptionsa...
...r Causes of Abnormal Liver Function Tests T...
...e 7. Conditions or Situations in W...
...8. Clinically Significant Drug–Dr...
...Suggested Pyrazinamide Doses, Using...
...uggested Ethambutol Dosages, Using Whole Tablets,...
...Dosing Recommendations for Adult Patients...