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...
...ctors to be Considered in Deciding to...
Treatment
...reatmen...
...nization and Supervision of Treatment...
...Recommendation Grad...
...ion 1: The panel suggests using case managemen...
...2: The panel suggests using DOT rather than SAT...
...ommended Treatment Regi...
...3a: The panel recommends the use of d...
...commendation 3b: Use of thrice-weekly therapy...
...3c: In situations where daily or thrice-weekly...
...ommendation 4a: The panel recommen...
...tion 4b: If intermittent therapy is to...
...endation 4c: The panel recommends against INH...
...ment in Special Situations...
...mendation 5a: For HIV-infected pati...
...ion 5b: In uncommon situations in which HIV-infe...
...: The panel recommends initiating ART du...
Extrapulmonary Tuberculos...
...tion 7: The panel suggests initial adjunctive cort...
...ommendation 8: The panel recommends initial adjun...
...ive Pulmonary Tuberculosis in Adults...
...n 9: The panel suggests that a 4-month...
.... Drug Regimens for Microbiologically C...
...Dosesa of Antituberculosis Drugs for Adult...
...e Components of a Multifaceted, Patien...
...mples of Priority Situations for th...
...ine And Follow-Up Evaluations For Patients...
...le 5. Management of Treatment Inte...
...ther Causes of Abnormal Liver Function...
...onditions or Situations in Which Therapeutic Dr...
...lly Significant Drug–Drug Interactions...
...ggested Pyrazinamide Doses, Using Whole Tablets, f...
...e 10. Suggested Ethambutol Dosages,...
...osing Recommendations for Adult Patien...