X hits on this document





7 / 8

Drugs for Tuberculosis

ception should be performed at the start of therapy, and monthly thereafter. The decision to use ethambutol in children too young to have visual acuity monitored must take into consideration the risk/benefit for each particular patient.45

Streptomycin causes ototoxicity (usually vestibular disturbance) and, less frequently, renal toxicity. Amikacin and kanamycin can cause tinnitus and high-frequency hearing loss. These drugs and capre- omycin can also cause renal and vestibular toxicity. Cycloserine can cause psychiatric symptoms and seizures. Ethionamide has been associated with gas- trointestinal, hepatic and thyroid toxicity. A delayed- release granular formulation of aminosalicylic acid (PAS) has better gastrointestinal tolerability than older formulations. Fluoroquinolones are usually well-tol- erated, but can cause gastrointestinal and CNS distur- bances, and dysglycemia can occur, particularly in the elderly and in patients with diabetes.


All initial isolates of M. tuberculosis should be tested for antimicrobial susceptibility. Initial therapy for most patients with active TB should include at least isoni- azid, rifampin, pyrazinamide and ethambutol until sus- ceptibility is known. Directly observed therapy (DOT) by a healthcare worker is the standard of care and should be offered to all patients with active TB to min- imize failure rates, relapse and the emergence of drug resistance. Confirmed multidrug-resistant tuberculosis (MDRTB) should be treated with DOT in collaboration with a clinician familiar with the management of the disease. Regimens for MDRTB must include at least 4 drugs to which the organism is susceptible; the dura- tion of therapy usually should be 18-24 months.

  • 1.

    Centers for Disease Control and Prevention (CDC). Trends in tuber- culosis — United States, 2005. MMWR Morb Mortal Wkly Rep 2006; 55:305.

  • 2.

    American Thoracic Society; CDC; Infectious Diseases Society of America. Treatment of tuberculosis. MMWR Recomm Rep 2003; 52 (RR-11):1.

  • 3.

    PC Hopewell et al. International standards for tuberculosis care. Lancet Infect Dis 2006; 6:710.

  • 4.

    TR Frieden and SS Munsiff. The DOTS strategy for controlling the global tuberculosis epidemic. Clin Chest Med 2005; 26:197.

  • 5.

    K DeRiemer et al. Does DOTS work in populations with drug-resist- ant tuberculosis? Lancet 2005; 365:1239.

  • 6.

    CR Horsburgh Jr. Priorities for the treatment of latent tuberbulosis infection in the United States. N Engl J Med 2004; 350:2060.

  • 7.

    KP Cain et al. Tuberculosis among foreign-born persons in the United States: achieving tuberculosis elimination. Am J Respir Crit Care Med 2007; 175:75.

  • 8.

    Centers for Disease Control and Prevention (CDC). Tuberculosis asso- ciated with blocking agents against tumor necrosis factor-alpha— California, 2002-2003. MMWR Morb Mortal Wkly Rep 2004; 53:683.

  • 9.

    KL Winthrop. Risk and prevention of tuberculosis and other serious opportunistic infections associated with the inhibition of tumor necro- sis factor. Nat Clin Pract Rheumatol 2006; 2:602.

  • 10.

    Centers for Disease Control and Prevention (CDC). Guidelines for using the QuantiFERON®-TB Gold test for detecting Mycobacterium tuberculosis infection, United States. MMWR Recomm Rep 2005;54 (RR-15):49.

  • 11.

    M Pai et al. New tools and emerging technologies for the diagnosis of tuberculosis: part I. Latent tuberculosis. Expert Rev Mol Diagn 2006; 6:413.

  • 12.

    Centers for Disease Control and Prevention (CDC). Targeted tuber- culin testing and treatment of latent tuberculosis infection. MMWR Recomm Rep 2000; 49 (RR-6):1.

  • 13.

    KR Page et al. Improved adherence and less toxicity with rifampin vs isoniazid for treatment of latent tuberculosis: a retrospective study. Arch Intern Med 2006; 166:1863.

  • 14.

    A Lardizabal et al. Enhancement of treatment completion for latent tuberculosis infection with 4 months of rifampin. Chest 2006; 130:1712.

  • 15.

    J Ena and V Valls. Short-course therapy with rifampin plus isoniazid, compared with standard therapy with isoniazid, for latent tuberculosis infection: a meta-analysis. Clin Infect Dis 2005; 40:670.

  • 16.

    Centers for Disease Control and Prevention (CDC); American

Thoracic Society. Update: Adverse event data and revised American Thoracic Society/CDC recommendations against the use of rifampin and pyrazinamide for treatment of latent tuberculosis infection – United States, 2003. MMWR Morb Mortal Wkly Rep 2003; 52:735.

  • 17.

    PD McElroy et al. National survey to measure rates of liver injury, hospitalization, and death associated with rifampin and pyrazinamide for latent tuberculosis infection. Clin Infect Dis 2005; 41:1125.

  • 18.

    T Papastavros et al. Adverse events associated with pyrazinamide and levofloxacin in the treatment of latent multidrug-resistant tuberculo- sis. CMAJ 2002; 167:131.

  • 19.

    R Ridzon et al. Asymptomatic hepatitis in persons who received alter- native preventive therapy with pyrazinamide and ofloxacin. Clin Infect Dis 1997; 24:1264.

  • 20.

    Centers for Disease Control and Prevention (CDC). Emergence of Mycobacterium tuberculosis with extensive resistance to second-line drugs — worldwide, 2000-2004. MMWR Morb Mortal Wkly Rep 2006; 55:301.

  • 21.

    Centers for Disease Control and Prevention (CDC). Revised defini- tion of extensively drug-resistant tuberculosis. MMWR Morb Mortal Wkly Rep 2006; 55:1176.

  • 22.

    NR Gandhi et al. Extensively drug-resistant tuberculosis as a cause of death in patients co-infected with tuberculosis and HIV in a rural area of South Africa. Lancet 2006; 368:1575.

  • 23.

    GL Woods. The mycobacteriology laboratory and new diagnostic techniques. Infect Dis Clin North Am 2002; 16:127.

  • 24.

    H Blumberg et al. Update on the treatment of tuberculosis and latent tuberculosis infection. JAMA 2005; 293:2776.

  • 25.

    GE Thwaites et al. Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. N Engl J Med 2004; 351:1741.

  • 26.

    M Weiner et al. Pharmacokinetics of rifapentine at 600, 900, and 1,200 mg during once-weekly tuberculosis therapy. Am J Respir Crit Care Med 2004; 169:1191.

  • 27.

    FM Gordin. Rifapentine for the treatment of tuberculosis: is it all it can be? Am J Respir Crit Care Med 2004; 169:1176.

  • 28.

    A Vernon et al. Acquired rifamycin monoresistance in patients with HIV-related tuberculosis treated with once-weekly rifapentine and iso- niazid. Tuberculosis Trials Consortium. Lancet 1999; 353:1843.

  • 29.

    B Blomberg and B Fourie. Fixed-dose combination drugs for tubercu- losis: application in standardised treatment regimens. Drugs 2003; 63:535.

  • 30.

    JA Caminero. Treatment of multidrug-resistant tuberculosis: evidence and controversies. Int J Tuberc Lung Dis 2006; 10:829.

Treatment Guidelines from The Medical Letter 21

Vol. 5 (Issue 55)

March 2007

Document info
Document views26
Page views26
Page last viewedWed Jan 18 06:55:42 UTC 2017