Treatment of tuberculosis and tuberculosis infection in adults and children. American Thoracic Society and The Centers for Disease Control and Prevention.

Abstract

Treatment of Tuberculosis. 1. A 6-mo regimen consisting of isoniazid, rifampin, and pyrazinamide given for 2 mo followed by isoniazid and rifampin for 4 mo is the preferred treatment for patients with fully susceptible organisms who adhere to treatment. Ethambutol (or streptomycin in children too young to be monitored for visual acuity) should be included in the initial regimen until the results of drug susceptibility studies are available, unless there is little possibility of drug resistance (i.e., there is less than 4% primary resistance to isoniazid in the community, and the patient has had no previous treatment with antituberculosis medications, is not from a country with a high prevalence of drug resistance, and has no known exposure to a drug-resistant case). This four-drug, 6-mo regimen is effective even when the infecting organism is resistant to INH. This recommendation applies to both HIV-infected and uninfected persons. However, in the presence of HIV infection it is critically important to assess the clinical and bacteriologic response. If there is evidence of a slow or suboptimal response, therapy should be prolonged as judged on a case by case basis. 2. Alternatively, a 9-mo regimen of isoniazid and rifampin is acceptable for persons who cannot or should not take pyrazinamide. Ethambutol (or streptomycin in children too young to be monitored for visual acuity) should also be included until the results of drug susceptibility studies are available, unless there is little possibility of drug resistance (see Section 1 above). If INH resistance is demonstrated, rifampin and ethambutol should be continued for a minimum of 12 mo. 3. Consideration should be given to treating all patients with directly observed therapy (DOT). 4. Multiple-drug-resistant tuberculosis (i.e., resistance to at least isoniazid and rifampin) presents difficult treatment problems. Treatment must be individualized and based on susceptibility studies. In such cases, consultation with an expert in tuberculosis is recommended. 5. Children should be managed in essentially the same ways as adults using appropriately adjusted doses of the drugs. This document addresses specific important differences between the management of adults and children. 6. Extrapulmonary tuberculosis should be managed according to the principles and with the drug regimens outlined for pulmonary tuberculosis, except for children who have miliary tuberculosis, bone/joint tuberculosis, or tuberculous meningitis who should receive a minimum of 12 mo of therapy.(ABSTRACT TRUNCATED AT 400 WORDS)

A Guide to the Management of Tuberculosis in Patients with Chronic Liver Disease

“…Hepatic damage is rare in patients less than 20 years old; it is observed in 0.3% of those in the 20-34 years age group, increasing to 1.2% in the 35-49 years age group and 2.3% in those older than 50 years of age. 26,27,[32][33][34] Up to 12% of patients receiving INH may have elevated plasma aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activities. 32,33 Recent treatment studies have reported significant transaminase elevation in 1-4% of those treated with INH for latent tuberculosis infection.…”

“…26,27,[32][33][34] Up to 12% of patients receiving INH may have elevated plasma aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activities. 32,33 Recent treatment studies have reported significant transaminase elevation in 1-4% of those treated with INH for latent tuberculosis infection. [33][34][35][36] A meta-analysis of six studies estimated the rate of clinical hepatitis in patients given INH alone to be 0.6%.…”

Pharmacokinetics and tissue distribution studies of orally administered nanoparticles encapsulated ethionamide used as potential drug delivery system in management of multi-drug resistant tuberculosis

“…Therefore, there is a need to develop a sustained release formulation of ethionamide to improve compliance by reducing the dosing frequency and to improve therapeutic effectiveness. Furthermore, ethionamide is a poorly tolerated drug and often administered with meals to reduce gastrointestinal intolerance (Bass et al, 1994). Ethionamide also undergoes first pass metabolism which reduces its oral bioavailability (Auclair et al, 2001).…”

N-Aroyl-3,5-bis(benzylidene)-4-piperidones: A novel class of antimycobacterial agents

“…These drugs are often administered over a period of six months 3 and this prolonged treatment leads on occasions to the development of drug resistance. 4 Thus novel classes of antimycobacterials are urgently required which have modes of action that are divergent from those drugs used in current therapy.…”