Tuberculosis: Which drug regimen and when

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Applied Evidence

Tuberculosis: Which drug regimen and when

J Fam Pract. 2015 January;64(1):27-33

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References

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If initial cultures are negative for Mycobacterium tuberculosis but the patient responds to treatment, he or she is considered to have “culture-negative TB,” and should generally be continued on INH and RIF for 2 more months after completion of the initial treatment phase (for a total of 4 months of INH and RIF).³³

Remember to report. In the United States, active TB must be reported to your local health department, which can be invaluable in coordinating care and administering DOT.

Who should receive directly observed therapy?

Directly observed therapy (DOT) is preferred for certain high-risk patients with latent tuberculosis infection (LTBI), including those who are younger than 5 years of age, test positive for human immunodeficiency virus, are receiving immunosuppressive therapy, have chest radiography evidence of healed TB, have recently converted to active TB status while receiving serial TB testing, or have recently been exposed to active TB.¹²

Treatment for active TB should always be given by DOT.¹³ Because DOT is labor-intensive, twice-weekly dosing is usually preferred.¹⁴

CASE › In the hospital, Mr. J was placed in respiratory isolation, had prompt sputum cultures for TB, and was started on empiric treatment for active TB with INH, RIF, PZA, and EMB in standard doses. A search for other causes of nonresponsiveness to CAP showed no evidence of malignancy or HIV infection. He improved steadily and was discharged from the hospital after 2 weeks to complete 2 months of 4-drug therapy, with follow-up care coordinated by the local health department, including a home health nurse experienced in administering DOT. Cultures were positive for Mycobacterium tuberculosis sensitive to all drugs tested. After his initial 2 months of 4-drug therapy, he completed 4 months of additional treatment with INH and RIF, given by DOT, and recovered completely.

CORRESPONDENCE
Jeff Hall, MD, University of South Carolina Department of Family and Preventive Medicine, 3209 Colonial Drive, Columbia, SC 29203; jeff.hall@uscmed.sc.edu