Executive Summary: 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.

Diabetes and Tuberculosis

“…Fourth, consideration should be given to measuring their drug concentrations in serum (therapeutic drug monitoring) to gain insights into the adequacy of drug dosing and need for tailored adjustments. If the DM patient has end stage renal disease, then therapeutic drug monitoring may be necessary to adjust drug levels in the context of dialysis, assess interactions with other medications for their co-morbid condition, and monitor toxicity (61). …”

Tracheobronchial tuberculosis

“…In general, antituberculous regimens consists of two phases: an intensive phase (2 months), followed by a continuation phase (4 to 7 months); most patients receive 6 months of treatment (intensive phase of 2 months and continuation phase of 4 months (34,35). Directly observed therapy (DOT) by enforcing compliance, has shown to improve the outcome in patients with pulmonary tuberculosis and thus decreasing resistance (34,35). However effect of DOT is not studied on patients with TBTB (4).…”

Gross Hematuria Is More Common in Male and Older Patients with Renal Tuberculosis in China: A Single-Center 15-Year Clinical Experience

“…A quadruple therapy for 2 months as an "intense phase" and dual therapy for 4 months as a "maintenance phase" are recommended in the American Thoracic Society and European Association of Urology guidelines [23,24] . Although surgical therapy is considered an adjunctive treatment to drug treatment for renal TB, it remains important in the treatment of patients with renal TB, particularly for extensive disease [8] .…”