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
...sessmen...
...Factors to be Considered in Deciding to I...
Treatment
...reatme...
...nization and Supervision of Treatment...
...ee Recommendation Gra...
...: The panel suggests using case management i...
...mendation 2: The panel suggests using DOT rat...
...mmended Treatment Reg...
...tion 3a: The panel recommends the use...
...3b: Use of thrice-weekly therapy in the inten...
...commendation 3c: In situations where daily or...
...4a: The panel recommends the use of daily or th...
...ion 4b: If intermittent therapy is to...
Recommendation 4c: The panel recommends agai...
...eatment in Special Situa...
...commendation 5a: For HIV-infected patients...
...dation 5b: In uncommon situations in wh...
...on 6: The panel recommends initiatin...
...rapulmonary Tuberculosis...
...commendation 7: The panel suggests initia...
...ommendation 8: The panel recommends i...
...re-Negative Pulmonary Tuberculosis in A...
...dation 9: The panel suggests that a 4-mo...
...ug Regimens for Microbiologically Confirm...
Table 2. Dosesa of Antituberculosis Drugs for...
...le Components of a Multifaceted, Patient-...
...amples of Priority Situations for the Use of...
...ine And Follow-Up Evaluations For Patient...
...e 5. Management of Treatment Inter...
...6. Other Causes of Abnormal Liver Fu...
...le 7. Conditions or Situations in Wh...
...cally Significant Drug–Drug Interac...
.... Suggested Pyrazinamide Doses, Using Whole Tabl...
...ested Ethambutol Dosages, Using Whole T...
.... Dosing Recommendations for Adult Patients W...