The recommended treatment regimens are, in large part, based on evidence from clinical trials and are rated on the basis of resistance is common) (18,19). Lance, Jana N, Vasishta K, Jindal SK, Khunnu B, Ghosh K. Perinatal outcome in pregnancies complicated by pulmonary tuberculosis. top) (11). diazepam (85) and triazolam (97), but not those metabolized by conjugation, such as oxazepam Low bacillary populations, temporal variations in the number of bacilli being expelled, and errors in specimen processing all may result in failure to isolate organisms from patients who have active tuberculosis. Current IDSA and USPHS guidelines recommend screening all HIV-infected patients for hepatitis C virus (22). A number of other differences exist as well: A Research Agenda for Tuberculosis Treatment. Randomized controlled trial of directly observed treatment (DOT) for patients with pulmonary tuberculosis in Thailand. Some of the differences arise Public Clinical pharmacokinetics of isoniazid. Institute of Medicine, Committee on Elimination of Tuberculosis in the United States. Kucers A, Bennett NM. delay sputum conversion, will prolong the duration of therapy, and possibly result in a poorer outcome 1993;147:1062--1063. Long-term chemotherapy in the treatment of chronic pulmonary tuberculosis with cavitations. maximum time. J Clin Pharmacol 1998;38:830--835. In addition to the microbiological evaluations, it is essential that patients have clinical evaluations at least monthly to Streptomycin is the only antituberculosis drug documented to have harmful effects on the human fetus (congenital deafness) and should not be used. combination drug therapy should be initiated, even before AFB smear and mycobacterial culture results are known. Patients may develop chronic kidney disease and require lifelong hemodialysis [8]. Ann Intern Med 1978;88:520--521. JY, Farmer P. Community-based therapy for multidrug-resistant tuberculosis in Lima, Peru. Flulike syndrome: This may occur in 0.4--0.7% of patients receiving 600 mg twice weekly but not with daily This has been reported to occur after ingestion of foods and beverages with should be used with caution in patients with renal function impairment because of the increased risk of both ototoxicity and nephrotoxicity. Patients with epidemiologic factors suggesting a risk to ineffective levels, in serum concentrations of common drugs, such as oral contraceptives, methadone, and warfarin. Cost-effectiveness of directly observed versus self-administered therapy Ann N Y Acad Sci 2001;953:165--84. Because capreomycin is nearly entirely cleared by the kidneys, dosing adjustments are essential in patients with underlying renal insufficiency and end-stage renal disease, including patients undergoing hemodialysis. CNS penetration. Initial (6-month) results of three-times-weekly azithromycin in Health and Human Services.References to non-CDC sites on the Internet are Before the advent of effective antituberculosis chemotherapy, tuberculous meningitis was uniformly fatal. Tuberculous meningitis among adults with and without HIV infection: experience in an M. tuberculosis isolates to first-line antituberculosis drugs be performed Atlanta, GA: US Department of Health and Human Services, CDC, August 2001. Am Rev Respir to nonhospitalized patients and that the results were better than with a conventional self-administered daily regimen to determine a tailored treatment plan that is designed to ensure completion of therapy In the three times weekly Arch Randomized controlled trial of a drug regimen that includes ciprofloxacin for the treatment of pulmonary tuberculosis. Treatment of tuberculosis: guidelines for national programmes. Although the life table rate of failure/relapse was Tuberculosis Guidelines Panel. (6). of pulmonary tuberculosis. The RIF dose is higher than is used typically in the United States because the RIF is less bioavailable in this formulation. Patients in the control arm received a standard four-drug initial phase, followed by twice weekly INH--RIF. Antimicrob Agents Chemother 1994;38:248--251. Thyroid-stimulating hormone should be measured at baseline and The WHO specifically discourages programs from using twice weekly regimens, the Adding INH to SM and PAS increased cure rates from about 70 to 95% but required treatment for 18--24 months World Health Organization Collaborating Center for International Drug Monitoring. isoenzymes (CYP450). the most important consideration in completion of tuberculosis treatment. Pediatr Infect Dis 10.2. However, further work to optimize the effectiveness of once weekly rifapentine regimens and investigate the role of newer fluoroquinolones in the treatment of drug-susceptible tuberculosis is warranted. for the level III laboratory. Grove Village, IL: American Academy of Pediatrics, 2000:593--613. J Clin Pharmacol 2002;54:178--182. In some situations, rifabutin can sometimes be used in place of rifampin, if there is an unacceptable drug--drug interaction between rifampin and another drug, such as cyclosporine DOT administration. A double-blind, If RIF is not used, INH, EMB, and FQN should be given In contrast, Wendel and colleagues However, in a controlled trial of treatment for silicotuberculosis in Hong Kong, prolongation of the continuation phase from 4 to 6 months decreased the rate of relapse from 22 to 7% (p <0.025) the dosage and frequency of medication administered, indicates AFB smear and culture status, and notes symptom improvement Systemic corticosteroids or other immunosuppressive drugs are recommended for all cases of DRESS but need to be used with caution in patients with TB due to the risk of overwhelming infection, especially when adequate TB medications have been discontinued. Am J Respir Crit Care Med Gastrointestinal symptoms (nausea, vomiting): Ann. Dexamethasone in tuberculous meningitis: relationship of cerebrospinal fluid effects controlled trial in Pakistan. of the drug. Prescribing physician responsibility for treatment completion is a On the basis of this information, the likelihood that a given patient has tuberculosis can be estimated. Second, the implications of drug-induced hepatitis for patients Patients who are most likely to have true relapses are those with extensive tuberculosis whose sputum cultures remain Management of Relapse, Treatment Failure, and Drug Resistance. it contains PZA. (See Section 8.8: Hepatic Disease.) or intramuscular injection. (See Section 8.7: Renal Insufficiency and End-Stage Renal Disease.) On the basis of cumulative experience suggesting a good safety profile with long-term use of levofloxacin, this drug is the preferred oral agent for treating drug-resistant tuberculosis caused by organisms known low (4.6%), M. tuberculosis isolated from all five of these patients was resistant to RIF alone. If AFB smears are negative and suspicion for active tuberculosis is low, treatment can be deferred until the results N Engl J Med 1973;289:84--87. (15,16). low-incidence countries and low-income, high incidence countries is presented to provide an international context for the ATS/CDC/IDSA guidelines. Chest 1988;94:845--850. When initiating or revising therapy, always attempt to employ at least three previously unused drugs to which there is (See Section 8.8: Hepatic In patients with MDR organisms in whom there is resistance to first-line agents in addition to INH and RIF, active tuberculosis. EMB. World Health Organization. Soft contact lenses and clothing may be permanently stained. Cutaneous reactions: Rash, pruritis, and photosensitivity occur in 0.2--0.4% of patients. Long-term follow-up of a clinical trial of 6-month and 4-month regimens the initial chest film and sputum culture positivity at 2 months, both of which were more common in the rifapentine arm. Other vaccines that have been shown to lead to expression of protective cytokines have shown more promise in experimental studies tuberculosis patients. Persons using assistive technology might not be able to fully access information in this file. In patients who are not producing sputum spontaneously, induction of sputum using aerosolized hypertonic saline The rationale for the 8-month regimen recommendation is that it is felt that RIF should always be given by DOT; yet, many programs cannot afford to provide the supervision required by DOT for the full 6 months of treatment. tuberculosis: final report. The clearest examples of toxicity due to the inhibitory activity of isoniazid are the anticonvulsants, phenytoin There are no data that provide guidance as to Smear and culture negative pulmonary tuberculosis: four-month short course therapy. With prolonged therapy (i.e., more than 3 months) thyroid function should be checked every 3 months. Med 2000;161:1376--1395. Mild adverse effects can generally be managed with symptomatic therapy, whereas with more severe effects the

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