Drug-Susceptible Tuberculosis

Publication Date: August 10, 2016

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

...sessment...

...ors to be Considered in Deciding to...


Treatment

...atment...

...and Supervision of Treatment...

See Recommendation Gradi...

...1: The panel suggests using case manage...

...ommendation 2: The panel suggests using DO...


...d Treatment Regimens...

...on 3a: The panel recommends the us...

...ation 3b: Use of thrice-weekly therapy in th...

...ation 3c: In situations where daily...

...4a: The panel recommends the use of...

...ommendation 4b: If intermittent ther...

...4c: The panel recommends against INH 90...


...ent in Special Situations...

...on 5a: For HIV-infected patients receiving AR...

...ion 5b: In uncommon situations in which...

...ecommendation 6: The panel recommends i...

...rapulmonary Tuberculosi...

...mmendation 7: The panel suggests initial...

...8: The panel recommends initial adjunctive c...

...gative Pulmonary Tuberculosis in Adults...

...: The panel suggests that a 4-month...


...Drug Regimens for Microbiologically Confir...


...able 2. Dosesa of Antituberculosis Drugs for Adu...


...sible Components of a Multifaceted,...


...able 4. Examples of Priority Situations for th...


...ure 2. Baseline And Follow-Up Evaluations For Pa...


...ent of Treatment InterruptionsaHavi...


Table 6. Other Causes of Abnormal...


...Conditions or Situations in Which The...


...ble 8. Clinically Significant Drug–Dr...


...ested Pyrazinamide Doses, Using Whole Tablet...


...sted Ethambutol Dosages, Using Whole Ta...


...osing Recommendations for Adult Patients With...