Pulmonology Book


Susceptible Tuberculosis Treatment

Aka: Susceptible Tuberculosis Treatment, Susceptible Tb Treatment
  1. See Also
    1. Tuberculosis
    2. Latent Tuberculosis Treatment
    3. Active Tuberculosis Treatment
    4. Possibly Resistant Tuberculosis Treatment
    5. Multiple Drug Resistant Tuberculosis Treatment
    6. Tuberculosis Screening in Children
    7. Tuberculosis Risk Factors (Tuberculosis Screening Indications)
    8. Tuberculosis Risk Factors for progression from Latent to Active Disease (Latent Tuberculosis Treatment Indications)
    9. Tuberculosis Related Chest XRay Changes
    10. Extrapulmonary Tuberculosis
    11. Tuberculin Skin Test (TST, Purified Protein Derivative, PPD)
    12. Mycobacterium Tuberculosis Antigen-Specific Interferon-Gamma Release Assay (IGRA)
    13. Tuberculosis Resources
  2. Indications
    1. Resistance rate in patient's Community <4%
      1. Most communities have Tb resistance >4%
    2. HIV Screening negative
    3. Immunocompetent
    4. No prior Tuberculosis Treatment v
  3. Management: Overview (requires 2 phases of therapy)
    1. Initial phase: 3-4 drug regimen for 2 months
      1. Medications (4 used together in initial phase)
        1. Isoniazid and
        2. Rifampin and
        3. Pyrazinamide and
        4. Ethambutol (unless not indicated by culture)
      2. Dose timing
        1. Take once daily for 8 weeks (56 doses) or
        2. Take five times weekly for 8 weeks (40 doses)
          1. Given under direct observation
    2. Continuation phase: Double therapy for 4-7 months
      1. Medications (2 used together in continuation phase)
        1. Isoniazid and
        2. Rifampin
      2. Dose timing (18 weeks unless otherwise noted below)
        1. Once daily or
        2. Five times per week (direct observation)
      3. Duration of treatment
        1. Double therapy for 18 weeks unless exceptions below
        2. Indications for 7 month continuation phase
          1. Cavitary pulmonary Tuberculosis
          2. Positive Sputum Culture after initial phase
  4. Resources
    1. CDC Tb Guidelines Treatment
      1. http://www.cdc.gov/tb/publications/guidelines/treatment.htm
    2. CDC Division of Tuberculosis Elimination
      1. http://www.cdc.gov/nchstp/tb/
  5. References
    1. (2003) MMWR Morb Mortal Wkly Rep 52(RR-11):1 [PubMed]
    2. Nahid (2016) Clin Infect Dis 63(7): e147-95 [PubMed]

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