Treatments for Tuberculosis
Treatments for Tuberculosis
The list of treatments mentioned in various sources
for Tuberculosis
includes the following list.
Always seek professional medical advice about any treatment
or change in treatment plans.
Tuberculosis: Is the Diagnosis Correct?
The first step in getting correct treatment is
to get a correct diagnosis.
Differential diagnosis list for Tuberculosis may include:
Hidden causes of Tuberculosis may be incorrectly diagnosed:
Tuberculosis: Marketplace Products, Discounts & Offers
Products, offers and promotion categories available for Tuberculosis:
Curable Types of Tuberculosis
Possibly curable types of Tuberculosis may include:
Tuberculosis: Research Doctors & Specialists
- Spinal Specialists:
- Urinary & Bladder Specialists (Urology):
- Kidney Health Specialists (Nephrology):
- Lung Health Specialists (Pulmonologist):
- more specialists...»
Research all specialists including ratings, affiliations, and sanctions.
Drugs and Medications used to treat Tuberculosis:
Note:You must always seek professional medical advice about any prescription drug, OTC drug, medication, treatment
or change in treatment plans.
Some of the different medications used in the treatment of Tuberculosis include:
- Prednisolone
- A&D w/Prednisolone
- Cortalone
- Delta-Cortef
- Duapred
- Fernisonone-P
- Hydelta-TBA
- Hydeltrasol
- Inflamase
- Inflamase Forte
- Key-Pred
- Meticortelone
- Meti-Derm
- Metreton
- Minims Prednisolone
- Mydrapred
- Niscort
- Nor-Pred
- Nova-Pred
- Novoprednisolone
- Optimyd
- Otobione
- Peidaject
- Pediapred
- Polypred
- Predcor
- Pred Forte
- Pred-G
- Pred Mild
- Prelone
- PSP-IV
- Savacort
- Sterane
- TBA Pred
- Pyrazinamide - used as part of a combination therapy
- PMS Pyrazinamide
- Rifater
- Tebrazid - used as part of a combination therapy
- Rifampin
- Rifadin
- Rifadin IV
- Rifamate
- Rimactane
- Rimactane/INH Dual Pack
- Rofact
- Aminosalicylate Sodium - used as part of a combination treatment
- Nemasol Sodium - used as part of a combination treatment
- Capreomycin - used as part of a combination treatment
- Capastat Sulfate - used as part of a combination treatment
- Ethionamide
- Trecator
- Braccoprial - used as part of a combination therapy
- Methambutol
- Myambutol
- Zinamide
Unlabeled Drugs and Medications to treat Tuberculosis:
Unlabelled alternative drug treatments for Tuberculosis include:
- Chlorpromazine - used as part of a combination therapy
- Chlorpromanyl - used as part of a combination therapy
- Largactil - used as part of a combination therapy
- Novochlorpromazine - used as part of a combination therapy
- Ormazine - used as part of a combination therapy
- Thora-Dex - used as part of a combination therapy
- Thorazine - used as part of a combination therapy
- Thorazine SR - used as part of a combination therapy
Hospital statistics for Tuberculosis:
These medical statistics relate to hospitals, hospitalization and Tuberculosis:
- 0.04% (5,666) of hospital episodes were for tuberculosis in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 0.12% (63,347) of hospital bed days were for tuberculosis in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 18.1 days was the mean length of stay in hospitals for tuberculosis in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 10 days was the median length of stay in hospitals for tuberculosis in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- more hospital information...»
Hospitals & Medical Clinics: Tuberculosis
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for hospitals and medical facilities in specialties related to Tuberculosis:
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More general information, not necessarily in relation to Tuberculosis,
on hospital and medical facility performance and surgical care quality:
Medical news summaries about treatments for Tuberculosis:
The following medical news items
are relevant to treatment of Tuberculosis:
Discussion of treatments for Tuberculosis:
Antimicrobial Resistance, NIAID Fact Sheet: NIAID (Excerpt)
Strains of multidrug-resistant tuberculosis (MDR-TB) have
emerged over the last decade and pose a particular threat to
people infected with HIV. Drug-resistant strains are as contagious
as those that are susceptible to drugs. MDR-TB is more difficult
and vastly more expensive to treat, and patients may remain
infectious longer due to inadequate treatment. (Source: excerpt from Antimicrobial Resistance, NIAID Fact Sheet: NIAID)
Tuberculosis, NIAID Fact Sheet: NIAID (Excerpt)
With appropriate antibiotic therapy, TB usually can be cured.
In recent years, however, drug-resistant cases of TB have
increased dramatically.
Drug resistance results when patients fail to take their
medicine consistently for the six to 12 months necessary to
destroy all vestiges of M. tuberculosis. In some U.S.
cities, more than 50 percent of patients — often homeless people,
drug addicts, and others caught in poverty — fail to complete
their prescribed course of TB therapy. One reason for this lack of
compliance is that TB patients may feel better after only two to
four weeks of treatment and stop taking their TB drugs, some of
which can have unpleasant side effects.
Resistance also may develop when patients are treated with too
few drugs or with inadequate doses.
Particularly alarming is the increase in the number of people
with multidrug-resistant TB (MDR-TB), caused by M.
tuberculosis strains resistant to two or more drugs. Even with
treatment, the death rate for MDR-TB patients is 40 to 60 percent,
the same as for TB patients who receive no treatment. For people
coinfected with HIV and MDR-TB, the death rate may be as high as
80 percent. The time from diagnosis to death for some patients
with MDR-TB and HIV may be only months as they are sometimes left
with no treatment options.
From 1993 to 1997, 43 states and the District of Columbia
reported cases of multidrug-resistant TB. In addition, CDC
received numerous reports of outbreaks of MDR-TB in hospitals and
prisons. During these outbreaks, MDR-TB has sometimes spread to
hospital patients, health care workers, prisoners, and prison
guards.
What Caused TB's
Resurgence?
During the 19th century, TB claimed more lives in the United
States than any other disease. Improvements in nutrition, housing,
sanitation, and medical care in the first half of the 20th century
dramatically reduced the number of cases and deaths. TB's decline
hastened in the 1940s and 1950s with the introduction of the first
effective antibiotic therapies for TB. By 1985, the number of
cases had fallen to 22,201 in the United States.
In 1985, however, the decline ended and the number of active TB
cases in the United States began to rise again. Several forces,
often interrelated, were behind TB's resurgence:
- The HIV/AIDS epidemic. People with HIV are particularly
vulnerable to reactivation of latent TB infections, as well as
to disease caused by new TB infections. TB transmission occurs
most frequently in crowded environments such as hospitals,
prisons, and shelters where HIV-infected individuals make up a
growing proportion of the population.
- Increased numbers of immigrants from countries with many
cases of TB, many of whom live in crowded housing. Because of
language and economic difficulties, many immigrants have limited
access to health care and may not receive treatment. TB cases
among immigrants increased from 4,925 in 1986 to 7,640 in 1998,
accounting for 42 percent of the national total.
- Increased poverty, injection drug use, and homelessness. TB
transmission is rampant in crowded shelters and prisons where
people weakened by poor nutrition, drug addiction, and
alcoholism are exposed to M. tuberculosis. People in poor
health, especially those infected with HIV, also are prone to
reactivation of latent TB infections.
- Poor compliance with treatment regimens, especially among
disadvantaged groups. Some of these people may remain contagious
while others develop and pass on resistant strains of M.
tuberculosis that are difficult to treat.
- Increased numbers of residents in long-term care facilities
such as nursing homes. Immune function declines with age, and as
patients live longer, many suffer recurrences of latent
infections often acquired in early adulthood. Other elderly
people, especially those with weak immune systems, become newly
infected with TB.
The TB Organism
TB is caused by repeated exposure to airborne droplets
contaminated with M. tuberculosis, a rod-shaped bacterium.
The TB bacterium also is known as the tubercle bacillus. (A small
fraction of cases are caused by related bacteria, M.
africanum and M. bovis.)
M. tuberculosis, like other mycobacteria, has an unusual
cell wall, a waxy coat comprised of fatty molecules whose
structure and function are not well known. This cell wall appears
to allow M. tuberculosis to survive in its preferred
environment: inside immune cells called macrophages, which
ordinarily degrade pathogens with enzymes. The coat of M.
tuberculosis also renders it impermeable to many common drugs.
Biologists call M. tuberculosis and other mycobacteria
"acid fast" bacteria because their fatty cell walls prevent the
cells from being decolorized by acid solutions after staining
during diagnostic tests.
Several factors make M. tuberculosis a difficult
organism to study in the laboratory, hampering TB research. The
bacteria multiply very slowly, only once every 24 hours, and take
a month to form a colony. By comparison, other bacteria such as
E. coli form colonies within eight hours. TB bacilli tend
to form clumps, which makes working with them and counting them
difficult. Most daunting, M. tuberculosis, a dangerous,
airborne organism, can be studied only in laboratories that have
specialized safety equipment.
Transmission
TB is primarily an airborne disease. The disease is not likely
to be transmitted through personal items belonging to those with
TB, such as clothing, bedding, or other items they have touched.
Adequate ventilation is the most important measure to prevent the
transmission of TB.
Because most infected people expel relatively few bacilli,
transmission of TB usually occurs only after prolonged exposure to
someone with active TB. On average, people have a 50 percent
chance of becoming infected with TB if they spend eight hours a
day for six months or 24 hours a day for two months working or
living with someone with active TB, researchers have
estimated.
People are most likely to be contagious when their sputum
contains bacilli, when they cough frequently and when the extent
of their lung disease, as revealed by a chest x-ray, is great. TB
is spread from person to person in microscopic droplets — droplet
nuclei — expelled from the lungs when a TB sufferer coughs,
sneezes, speaks, sings, or laughs. Only people with active disease
are contagious.
Droplet nuclei are tiny and may remain in the air for prolonged
periods, ready to be inhaled. They are small enough to bypass the
natural defenses of upper respiratory passages, such as hairs in
the nose or the hairlike cilia in the bronchial tubes. Infection
begins when the bacilli reach the tiny air sacs of the lungs known
as alveoli, where they multiply within macrophages.
People who have been treated with appropriate drugs for at
least two weeks usually are not infectious.
Infection
The site of initial infection is usually the alveoli — the
balloonlike sacs at the ends of the small air passages in the
lungs known as bronchioles. In the alveoli, white blood cells
called macrophages ingest the inhaled M. tuberculosis
bacilli.
Some of the bacilli may be killed immediately; others may
multiply within the macrophages. Infrequently, but especially in
HIV-infected people and in children, the bacilli spread to other
sites in the body. This dissemination sometimes results in
life-threatening meningitis and other problems.
During the two to eight weeks after initial infection in people
with intact immune systems, macrophages present pieces of the
bacilli, displayed on their cell surfaces, to another type of
white blood cell — the T cell. When stimulated, T cells release an
elaborate array of chemical signals. Once this response, called
cell-mediated hypersensitivity, is established, a person's T cells
usually will respond to the tuberculin skin test (PPD test) and
produce a characteristic red welt.
Some of the T-cell signals produce inflammatory reactions;
other signals recruit and activate specialized cells to kill
bacilli and wall-off infected macrophages in tiny, hard grayish
nodules known as tubercles.
From then on the body's immune system maintains a standoff with
the infection, sometimes for years. In the tubercles, TB bacilli
may persist within macrophages, but further multiplication and
spread of M. tuberculosis are confined. Most people undergo
complete healing of their initial infection, and the tubercles
calcify and lose their viability. A positive TB skin test, and in
some cases a chest x-ray, may provide the only evidence of the
infection.
If, however, the body's resistance is low because of aging,
infections such as HIV, malnutrition, or other factors, the
bacilli may break out of the tubercles in the alveoli and cause
active disease.
Active Disease
On the average, people infected with M. tuberculosis
have a 10 percent chance of developing active TB at some time in
their lives. The risk of developing active disease is greatest in
the first year after infection, but active disease often does not
occur until many years later.
Active TB usually results from the spread of bacilli from the
alveoli through the bloodstream or lymphatic system to other
sites, usually elsewhere in the lungs or local lymph nodes. In 15
percent of cases, the bacilli cause disease in other regions, such
as the skin, kidneys, bones, or reproductive and urinary
systems.
At the new sites, the body's immune defenses kill many bacilli,
but immune cells and local tissue die as well. The dead cells and
tissue, along with live immune cells, form granulomas whose
centers have the consistency of soft cheese, where the bacilli
survive but do not flourish. The early symptoms of active TB can
include weight loss, fever, night sweats, and loss of appetite, or
they may be vague and go unnoticed by the affected individual.
As more lung tissue is destroyed and the granulomas expand,
cavities in the lungs develop, and sometimes break into larger
airways called bronchi. This allows large numbers of bacilli to
spread when patients cough. As the disease progresses, the
granulomas may liquefy, perhaps as a result of enzymes secreted by
the body's own immune cells. This creates a rich medium in which
the bacilli multiply rapidly and spread, creating further lesions
and the characteristic chest pain, cough, and, when a blood vessel
is eroded, bloody sputum.
Most patients do not suffer shortness of breath until the lungs
are extensively damaged by the formation of cavities. Symptoms of
TB involving areas other than the lungs vary, depending upon the
organ affected.
Diagnosing TB
The tuberculin skin test, also known as the Mantoux test, can
identify most people infected with tubercle bacilli six to eight
weeks after initial exposure. A substance called purified protein
derivative (PPD) is injected under the skin of the forearm and
examined 48 to 72 hours later. If a red welt forms around the
injection site, the person may have been infected with M.
tuberculosis, but doesn't necessarily have active disease.
Most people with previous exposure to TB will test positive on the
tuberculin test, as will some people exposed to related
mycobacteria. An important exception is people with severely
weakened immune systems, such as those with HIV.
If a person has a significant reaction to the tuberculin skin
test, additional methods can determine if the individual has
active TB. This is sometimes difficult because TB can mimic other
diseases, such as pneumonia, lung abscesses, tumors, and fungal
infections, or occur along with them. In making a diagnosis,
doctors rely on symptoms and other physical signs, a person's
history of exposure to TB, and x-rays that may show evidence of TB
infection, usually in the form of cavities or lesions in the
lungs.
The physician also will take sputum and other samples, because
a positive bacteriologic culture of M. tuberculosis is
essential to confirm the diagnosis and determine which drugs will
work against the strain of TB the patient carries. Because M.
tuberculosis grows very slowly, the laboratory diagnosis
requires approximately four weeks. An additional two to three
weeks usually are needed to determine the drug susceptibility of
the organism, making treatment decisions
difficult.
Advances in Diagnosis
Recently, researchers supported by the National Institute of
Allergy and Infectious Diseases (NIAID) as well as other
investigators developed tests that use nucleic acid amplification
to speed the diagnosis of TB from four weeks to two days. Another
test in development uses luminescent chemicals from the firefly to
determine, in 24 to 48 hours, which drugs can kill the TB strain a
patient carries.
Treatment of Active Disease
The death rate for untreated TB patients is between 40 and 60
percent. With appropriate antibiotics, however, people with
drug-susceptible cases of TB can be cured more than 90 percent of
the time.
Successful management of TB depends on close cooperation
between the patient and physicians and other health care workers.
Patient education is essential, and many doctors opt for
supervised, directly observed therapy (DOT). Treatment usually
combines the drugs isoniazid (INH) and rifampin, which are given
for at least six months, and pyrazinamide and ethambutol (or
streptomycin), which are used only in the first two months of
treatment. This treatment is referred to as short-course
chemotherapy.
Therapy for MDR-TB
Treatment for MDR-TB often requires the use of a second line of
TB drugs, all of which can produce serious side effects. Therapy
for 18 months to two years may be necessary, and patients should
receive at least three drugs to which the bacteria are
susceptible.
Prevention
TB is largely a preventable disease. In the United States,
prevention has focused on identifying infected individuals early —
especially those who run the highest risk of developing active
disease — and treating them with drugs in a program of directly
observed therapy.
INH prevents the disease in most people in close contact with
infected people or who are infected with the tubercle bacilli but
who do not have active TB. The drug is given daily for six to 12
months and strict patient compliance in taking medication is
essential to prevent drug-resistant strains from emerging. Adverse
reactions to INH are rare, although a small percentage of
patients, especially those older than 35, suffer INH-related
hepatitis. Rifampin for one year is recommended for close contacts
of patients with INH-resistant TB organisms.
In the United States, people with any of the following risk
factors should be considered for preventive therapy, regardless of
age, if they have not been previously treated for TB:
- Close contacts of people with newly diagnosed infectious TB;
(In addition, children and adolescents who react negatively to
the PPD test, but who have been in close contact with infectious
people within the past three months, should be considered for
preventive therapy. Therapy should continue until a second skin
test is done 12 weeks after their first contact with an
infectious person.)
- People with positive tuberculin skin tests and abnormal
chest x-rays compatible with inactive TB (lesions caused by
prior disease);
- People whose skin test results have recently converted from
negative to positive;
- People with positive skin test reactions who also have
special medical conditions known to increase the risk of TB
(e.g., HIV infection, diabetes mellitus) or who are on
corticosteroid therapy;
- HIV-positive people or those suspected to be HIV-infected
who now have, or had at any time in the past, positive skin test
reactions, but who do not have active infection; and
- Injection drug users who have positive skin test reactions.
In addition, people younger than 35 in the following groups
should be considered for preventive therapy if they have positive
skin test reactions:
- Foreign-born people from countries where TB is common;
- People in medically underserved, low-income groups,
especially African Americans, Hispanics, and Native Americans;
and
- Residents of long-term care facilities such as prisons,
nursing homes, and mental institutions.
Health care workers in frequent contact with TB patients or
involved with high-risk procedures such as those that induce
coughing should have a skin test every six months.
Hospitals and clinics caring for high-risk populations can take
precautions to prevent the spread of TB. All patients should be
taught to cover their mouths and noses when coughing or sneezing.
Ultraviolet light can be used to sterilize the air, and negative
pressure rooms and special filters are available, as are special
respirators and masks, that filter out the droplet nuclei. Until
they are no longer infectious, hospitalized TB patients should be
isolated in rooms with controlled ventilation and air
flow.
More Effective Vaccines are
Needed
In those parts of the world where the disease is common, a
vaccine composed of live, attenuated (weakened) mycobacteria from
cows (M. bovis, called bacillus Calmette-Guerin [BCG]) is
given to infants as part of the immunization program recommended
by the World Health Organization (WHO). In infants, BCG prevents
the spread of M. tuberculosis within the body, but does not
prevent initial infection.
In adults, the effectiveness of BCG has varied widely in
large-scale studies. In addition, positive skin test reactions
occur in people who have received BCG vaccine, thus limiting the
effectiveness of the PPD skin test to identify new infections. As
a result, BCG is not recommended for general use in the United
States. Because of BCG's limitations, more effective vaccines are
needed.
TB and HIV Infection
WHO estimates that 4.4 million people worldwide are coinfected
with TB and HIV. By the year 2000, TB will claim 1 million lives
annually among the HIV-infected, WHO projects, making TB the
leading cause of death in HIV-infected individuals. In the United
States, an estimated 100,000 HIV-infected people also carry M.
tuberculosis, according to CDC.
TB frequently occurs early in the course of HIV infection,
often months to years before other opportunistic infections such
as Pneumocystis carinii pneumonia. TB may be the first
indication that a person is HIV-infected, and often occurs in
areas outside the lungs, particularly in the later stages of HIV
disease.
In the United States, people coinfected with TB and HIV develop
active TB at a rate of about 8 percent each year. By
comparison, otherwise healthy individuals infected with M.
tuberculosis have a 10 percent lifetime risk of
developing active TB. People with HIV also are at greater risk of
having a new infection progress directly to active disease.
MDR-TB in people coinfected with HIV appears to have a more
rapid and deadly disease course than seen in patients with MDR-TB
who are otherwise healthy.
Diagnosing TB in HIV-infected people is often difficult. These
patients frequently have conditions that produce symptoms similar
to those of TB, and may not react to the standard tuberculin skin
test because their immune systems are suppressed. Although
investigators have hypothesized that a two-stage TB skin test
might be more reliable than a single-stage test in HIV-infected
individuals, a recently completed NIAID study found this not to be
the case.
X-rays, sputum smears, and physical exams may also fail to
provide an indication of TB infection in HIV-infected individuals.
As a consequence, doctors must often decide to begin anti-TB
therapy in HIV-infected people suspected of having active TB while
waiting for the results of cultures of sputum or other specimens.
NIAID Research Agenda for
Tuberculosis
NIAID, the lead institute for TB research at the National
Institutes of Health, supports more than 100 research projects
related to TB. In fiscal year 1999, NIAID will devote an estimated
$40 million to TB research.
NIAID has a comprehensive TB research agenda that supports the
following:
- Studies of the epidemiology and natural history of TB.
- Basic research into the biology of TB and the host immune
response to M. tuberculosis.
- The development of new tools to diagnose TB.
- The development of new drugs or new ways to deliver standard
drugs.
- Clinical trials of anti-TB therapies.
- The development of new vaccines to prevent TB.
- Training to increase the number of TB researchers.
- New ways to educate health care workers and the public about
TB prevention.
This multi-disciplinary program draws on the Institute's
expertise in immunology and microbiology, as well as its
capabilities in drug and vaccine development honed as part of the
research effort in AIDS and other infectious
diseases.
(Source: excerpt from
Tuberculosis, NIAID Fact Sheet: NIAID)
Tuberculosis, NIAID Fact Sheet: NIAID (Excerpt)
The death rate for untreated TB patients is between 40 and 60
percent. With appropriate antibiotics, however, people with
drug-susceptible cases of TB can be cured more than 90 percent of
the time.
Successful management of TB depends on close cooperation
between the patient and physicians and other health care workers.
Patient education is essential, and many doctors opt for
supervised, directly observed therapy (DOT). Treatment usually
combines the drugs isoniazid (INH) and rifampin, which are given
for at least six months, and pyrazinamide and ethambutol (or
streptomycin), which are used only in the first two months of
treatment. This treatment is referred to as short-course
chemotherapy.
Therapy for MDR-TB
Treatment for MDR-TB often requires the use of a second line of
TB drugs, all of which can produce serious side effects. Therapy
for 18 months to two years may be necessary, and patients should
receive at least three drugs to which the bacteria are
susceptible. (Source: excerpt from Tuberculosis, NIAID Fact Sheet: NIAID)
Tuberculosis: NWHIC (Excerpt)
If you have TB disease, you will need to take several different drugs.
This is because there are many bacteria to be killed. Taking several drugs
will do a better job of killing all of the bacteria and preventing them
from becoming resistant to the drugs.
If you have TB of the lungs or throat, you are probably infectious. You
need to stay home from work or school so that you don't spread TB bacteria
to other people. After taking your medicine for a few weeks, you will feel
better and you may no longer be infectious to others. Your doctor or nurse
will tell you when you can return to work or school.
Having TB should not stop you from leading a normal life. When you are
no longer infectious or feeling sick, you can do the same things you did
before you had TB. The medicine that you are taking should not affect your
strength, sexual function, or ability to work. If you take your medicine
as your doctor or nurse tells you, the medicine will kill all the TB
bacteria. This will keep you from becoming sick again.
(Source: excerpt from Tuberculosis: NWHIC)
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Tuberculosis:
Treatment
(Professional Guide to Diseases (Eighth Edition))
First-line agents for the treatment of TB are isoniazid (INH), rifampin (RIF), ethambutol (EMB), and pyrazinamide. Latent TB is usually treated with daily INH for 9 months. RIF daily for 4 months may be used for people with latent TB whose contacts are INH resistant. For most adults with active TB, the recommended dosing includes the administration of all four drugs daily for 2 months, followed by 4 months of INH and RIF. Drug therapy must be selected according to patient condition and organism susceptibility. Another first-line drug used for TB is rifapentine. Second-line agents, such as cycloserine, ethionamide, p-Aminosalicylic acid, streptomycin, and capreomycin, are reserved for special circumstances or drug-resistant strains. Interruption of drug therapy may require initiation of therapy from the beginning of the regimen or additional treatment.
Directly observed therapy (DOT) may be selected or required. In this therapy, an assigned caregiver directly observes the administration of the drug. The goal of DOT is to monitor the treatment regimen and reduce the development of resistant organisms.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Tuberculosis:
Treatment
(Handbook of Diseases)
Treatment includes antitubercular therapy with daily oral doses of isoniazid, rifampin, and pyrazinamide (and sometimes ethambutol) for at least 6 months. Longer courses may be required for patients with AIDS or for patients who respond slowly. After 2 to 4 weeks, the disease generally is no longer infectious. The patient can resume his normal lifestyle while taking medication.
Patients with atypical mycobacterial disease or drug-resistant TB may require treatment with second-line drugs, such as capreomycin, streptomycin, para-aminosalicylic acid, cycloserine, amikacin, and quinolone drugs.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Do not routinely test children for tuberculosis (TB) exposure:
Treatment
(Avoiding Common Pediatric Errors)
Isoniazid is the most-widely used of the antituberculosis agents—it is bactericidal, relatively nontoxic, easily administered, and inexpensive. It is often
given in combination with other drugs like rifampin (which has some important side effects, including hepatitis and thrombocytopenia), and pyrazinamide (which also adversely affects the liver). Multidrug resistance can
become a problem in treating TB, especially if a proper regimen is not implemented and adhered to. For these reasons, directly observed therapy and
the simultaneous use of multiple agents has become common.
» READ BOOK EXCERPT ONLINE »
Source: Avoiding Common Pediatric Errors, 2008
Pediatric Tuberculosis:
Management of Latent Infection
(Pediatric Infectious Disease)
Children who have a positive TST require a chest x-ray. In children younger than
18 years of age with a positive TST and negative chest x-ray, the diagnosis of
latent tuberculous infection is made. Monotherapy is acceptable only in the
case of latent tuberculosis infection. Patients younger than 18 years of age
who have latent infection with an isoniazid-sensitive organism are treated with
isoniazid for 9 months.
Latent infection with an isoniazid-resistant organism is treated with a 6-month
course
of oral rifampin. Children younger than 5 years of age have a very high risk for
severe tuberculosis when exposed to a contagious index case. Even if such a
child
’s first TST is negative, it is recommended that antituberculosis medication be
given. Medication can then be discontinued if a second TST 3 months later
remains negative and the child has no clinical signs of tuberculosis.
Previously, the Centers for Disease Control (CDC) recommended prophylaxis with
pyrazinamide and ethambutol for patients exposed to isoniazid- and
rifampin-resistant mycobacteria. Surveillance done by the CDC has reported
numerous cases of severe liver injury in patients receiving this prophylaxis.
The updated recommendation is for clinicians to practice extreme caution in
treating latent infection with the combination of pyrazinamide and ethambutol,
especially if there are risk factors for liver injury, including concurrent
hepatotoxic medications or alcohol consumption. Patients who elect to take this
regimen should be followed closely, both clinically and with frequent
measurement of serum aminotransferase levels.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Infectious Disease, 2004
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