Treatment of Tuberculosis

The recommendations in this document are intended to guide the treatment of tuberculosis in settings where mycobacterial cultures, drug susceptibility testing, radiographic facilities, and second-line drugs are routinely available. In areas where these resources are not available, the recommendations provided by the World Health Organization, the International Union against Tuberculosis, or national tuberculosis control programs should be followed.

What's New In This Document

* The responsibility for successful treatment is clearly assigned to the public health program or private provider, not to the patient.
* It is strongly recommended that the initial treatment strategy utilize patient-centered case management with an adherence plan that emphasizes direct observation of therapy.
* Recommended treatment regimens are rated according to the strength of the evidence supporting their use. Where possible, other interventions are also rated.
* Emphasis is placed on the importance of obtaining sputum cultures at the time of completion of the initial phase of treatment in order to identify patients at increased risk of relapse.
* Extended treatment is recommended for patients with drug-susceptible pulmonary tuberculosis who have cavitation noted on the initial chest film and who have positive sputum cultures at the time 2 months of treatment is completed.
* The roles of rifabutin, rifapentine, and the fluoroquinolones are discussed and a regimen with rifapentine in a once-a-week continuation phase for selected patients is described.
* Practical aspects of therapy, including drug administration, use of fixed-dose combination preparations, monitoring and management of adverse effects, and drug interactions are discussed.
* Treatment completion is defined by number of doses ingested, as well as the duration of treatment administration.
* Special treatment situations, including human immunodeficiency virus infection, tuberculosis in children, extrapulmonary tuberculosis, culture-negative tuberculosis, pregnancy and breastfeeding, hepatic disease and renal disease are discussed in detail.
* The management of tuberculosis caused by drug-resistant organisms is updated.
* These recommendations are compared with those of the WHO and the IUATLD and the DOTS strategy is described.
* The current status of research to improve treatment is reviewed.

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