Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis

Abstract

The American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America jointly sponsored the development of this guideline for the treatment of drug-susceptible tuberculosis, which is also endorsed by the European Respiratory Society and the US National Tuberculosis Controllers Association. Representatives from the American Academy of Pediatrics, the Canadian Thoracic Society, the International Union Against Tuberculosis and Lung Disease, and the World Health Organization also participated in the development of the guideline. This guideline provides recommendations on the clinical and public health management of tuberculosis in children and adults in settings in which mycobacterial cultures, molecular and phenotypic drug susceptibility tests, and radiographic studies, among other diagnostic tools, are available on a routine basis. For all recommendations, literature reviews were performed, followed by discussion by an expert committee according to the Grading of Recommendations, Assessment, Development and Evaluation methodology. 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. Additional characteristics such as presence of comorbidities, severity of disease, and response to treatment influence management decisions. Specific recommendations on the use of case management strategies (including directly observed therapy), regimen and dosing selection in adults and children (daily vs intermittent), treatment of tuberculosis in the presence of HIV infection (duration of tuberculosis treatment and timing of initiation of antiretroviral therapy), as well as treatment of extrapulmonary disease (central nervous system, pericardial among other sites) are provided. The development of more potent and better-tolerated drug regimens, optimization of drug exposure for the component drugs, optimal management of tuberculosis in special populations, identification of accurate biomarkers of treatment effect, and the assessment of new strategies for implementing regimens in the field remain key priority areas for research. See the full-text online version of the document for detailed discussion of the management of tuberculosis and recommendations for practice.

Rifamycin action on RNA polymerase in antibiotic-tolerant Mycobacterium tuberculosis results in differentially detectable populations

“…If not treated, active TB is contagious and usually lethal. Although treatment can be curative, the currently recommended drug regimens for both latent infection and active disease require at least 6 mo of therapy, have significant side effects and drug-drug interactions (2)(3)(4)(5), and are becoming ineffective as drug resistance mounts (1,6). Limited understanding of clinically latent and drug-tolerant states of Mycobacterium tuberculosis (Mtb) hampers development of effective new drugs.…”

The ERS-endorsed official ATS/CDC/IDSA clinical practice guidelines on treatment of drug-susceptible tuberculosis

“…This editorial provides a brief summary of the panel's recommendations; additional important information providing context and references for each recommendation, as well as detailed guidance on the management of TB in special populations, treatment of TB in the presence of HIV infection, TB in children, TB during pregnancy and breastfeeding, and extrapulmonary TB among other clinical situations is available in the full version of the guidelines [13]. Additional detailed guidance on the practical aspects of anti-TB treatment, drug-drug interactions, therapeutic drug monitoring (TDM) and management of adverse events is also available in the full version of the guideline.…”

“…Consequently, the American Thoracic Society (ATS) and the European Respiratory Society (ERS) have developed TB guidelines focused predominantly on TB care in settings without significant resource limitations [11,12], which have now been updated. Using GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methodology, the ATS, Centers for Disease Control and Prevention (CDC) and Infectious Diseases Society of America (IDSA) jointly sponsored the development of new treatment of drug-susceptible TB clinical practice guidelines, which have been subsequently endorsed by both the ERS and the US National Tuberculosis Controllers Association, and were published in Clinical Infectious Diseases [13].…”

Monitoring and Evaluation of Program Performance and Management Control System of Tuberculosis: A Ten-Year Cross-Sectional Study in Sistan and Baluchestan Province, Iran

“…It is recognized as one of the major causes of mortality in developing countries (1). According to reports by the World Health Organization (WHO), about two billion people around the world have been infected with TB, and 10 to 20 million new TB cases are added to this number annually, 95% of which is attributed to developing countries (1)(2)(3). Nearly 1.3 million children are infected with TB every year around the world, and 450 000 children die annually due to TB (2)(3)(4).…”