The major goals of treatment for TB disease are to • Cure the individual patient; • Minimize risk of death and disability; and • Reduce transmission of . M. tuberculosis. to other persons. To ensure that these goals are met, TB disease must be treated for at least 6 months and in some cases even longer.
Full Answer
What are the treatment goals for tuberculosis (TB)?
Responsibility for Successful Treatment. The overall goals for treatment of tuberculosis are 1) to cure the individual patient, and 2) to minimize the transmission of Mycobacterium tuberculosis to other persons.
How can we improve the treatment of drug-susceptible tuberculosis?
New drugs and new combinations of already known drugs have been tested in tuberculosis treatment with the aims of reducing treatment duration and increasing treatment effectiveness in cases of drug-susceptible tuberculosis and in cases of MDR-TB.
What is effective tuberculosis case management?
Effective tuberculosis case management identifies and characterizes the terrain and determines an appropriate care plan based on each of the identified factors.
What is the health department's role in the control of tuberculosis?
The responsibility of the health department in the control of tuberculosis is to ensure that all persons who are suspected of having tuberculosis are identified and evaluated promptly and that an appropriate course of treatment is prescribed and completed successfully ( 1 ,2 ).
What are the goals of tuberculosis treatment?
The major goals of treatment for TB disease are to • Cure the individual patient; • Minimize risk of death and disability; and • Reduce transmission of M. tuberculosis to other persons. To ensure that these goals are met, TB disease must be treated for at least 6 months and in some cases even longer.
What is the treatment plan for patients having TB?
You'll be prescribed at least a 6-month course of a combination of antibiotics if you're diagnosed with active pulmonary TB, where your lungs are affected and you have symptoms. The usual treatment is: 2 antibiotics (isoniazid and rifampicin) for 6 months.
What are basic principles of treatment of patients with tuberculosis?
The treatment of tuberculosis (TB) must satisfy the following basic therapeutic principles: Any regimen must use multiple drugs to which Mycobacterium tuberculosis is susceptible. The medications must be taken regularly. The therapy must continue for a period sufficient to resolve the illness.
What is first line treatment for TB?
TB can be treated effectively by using first line drugs (FLD) isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), ethambutol (EMB) and streptomycin (SM). However, this first line therapy often fails to cure TB for several reasons.
What is TB prevention?
The risk of infection can be reduced by using a few simple precautions: good ventilation: as TB can remain suspended in the air for several hours with no ventilation. natural light: UV light kills off TB bacteria. good hygiene: covering the mouth and nose when coughing or sneezing reduces the spread of TB bacteria.
What are the basic principles of treatment?
What are the principles of treatment? The principles of treatment are to reduce the effect and kill the cause of the diseases.
What is the most important principle for tuberculosis control?
Administrative controls are the first and most important level of the hierarchy. These are management measures that are intended to reduce the risk or exposure to persons with infectious TB.
What are the principles of treatment of disease Class 9?
There are primarily two ways to treat a disease: 1. Reduce the effect of the disease: Medicines are provided to reduce the pain or bring down the fever. In other words, symptomatical treatment may help to reduce the impact of a disease, but it might not outright cure it.
What are the goals of tuberculosis treatment?
The overall goals for treatment of tuberculosis are 1) to cure the individual patient, and 2) to minimize the transmission of Mycobacterium tuberculosis to other persons. Thus, successful treatment of tuberculosis has benefits both for the individual patient and the community in which the patient resides.
What is the most successful treatment for tuberculosis?
Treatment of patients with tuberculosis is most successful within a comprehensive framework that addresses both clinical and social issues of relevance to the patient. It is essential that treatment be tailored and supervision be based on each patient's clinical and social circumstances (patient-centered care). Patients may be managed in the private sector, by public health departments, or jointly, but in all cases the health department is ultimately responsible for ensuring that adequate, appropriate diagnostic and treatment services are available, and for monitoring the results of therapy.
Why are antituberculosis drugs needed?
New antituberculosis drugs are needed for three main reasons: 1) to shorten or otherwise simplify treatment of tuberculosis caused by drug-susceptible organisms, 2) to improve treatment of drug-resistant tuberculosis, and 3) to provide more efficient and effective treatment of latent tuberculosis infection.
How many subpopulations of tuberculosis are there?
It is theorized that there are three separate subpopulations of M. tuberculosis within the host. These populations are defined by their growth characteristics and the milieu in which they are located ( 1 ). The largest of the subpopulations consists of rapidly growing extracellular bacilli that reside mainly in cavities. This subpopulation, because of its size, is most likely to harbor organisms with random mutations that confer drug resistance. The frequency of these mutations that confer resistance is about 10 -6 for INH and SM, 10 -8 for RIF, and 10 -5 for EMB; thus, the frequency of concurrent mutations to both INH and RIF, for example, would be 10 -14, making simultaneous resistance to both drugs in an untreated patient a highly unlikely event ( 2 ).
What is the purpose of chemo for tuberculosis?
As noted previously, antituberculosis chemotherapy is both a personal health measure intended to cure the sick patient and a basic public health strategy intended to reduce the transmission of Mycobacterium tuberculosis. Typically, tuberculosis treatment is provided by public health departments, often working in collaboration with other providers and organizations including private physicians, community health centers, migrant health centers, correctional facilities, hospitals, hospices, long-term care facilities, and homeless shelters. Private providers and public health departments may cosupervise patients, assuring that the patient completes therapy in a setting that is not only mutually agreeable but also enables access to tuberculosis expertise and resources that might otherwise not be available. In managed care settings delivery of tuberculosis treatment may require a more structured public/private partnership, often defined by a contract, to assure completion of therapy. Regardless of the means by which treatment is provided, the ultimate legal authority for assuring that patients complete therapy rests with the public health system.
Why is it important to obtain sputum cultures at the time of completion of the initial phase of treatment?
Emphasis is placed on the importance of obtaining sputum cultures at the time of completion of the initial phase of treatment in order to identify patients at increased risk of relapse.
What is the choice of a regimen influenced by?
For the relatively few patients in whom epidemiologic circumstances provide a strong suspicion of exogenous reinfection as the cause of apparent relapse, the choice of a regimen is influenced by the drug susceptibility pattern of the presumed source case. If the presumed source case is known to have tuberculosis caused by drug-susceptible organisms, resumption of a standard four-drug initial phase may be indicated. However, if the likely source case is known to have drug-resistant organisms, an empirically expanded regimen based on the resistance profile of the putative source case may be suitable.
How to educate patients about TB?
Educating patients about TB disease helps ensure their successful completion of therapy. Health-care providers must take the time to explain clearly to patients what medication should be taken, how much, how often, and when. Patients should be clearly informed about possible adverse reactions to the medications they are taking and when to seek necessary medical attention. Providing patients with the knowledge they need regarding the consequences of not taking their medicine correctly is very important. In addition, patients should be educated about infection control measures and potential need for isolation (Table 6.1). HIV testing and counseling is recommended for all patients with TB disease in all health-care settings. The patient must first be notified that testing will be performed. The patient has the right to decline HIV testing and counseling (opt-out screening).
How long does it take to treat TB?
As a general rule, the principles used for the treatment of pulmonary TB disease also apply to extrapulmonary forms of the disease. A 6-month treatment regimen is recommended for patients with extrapulmonary TB disease, unless the organisms are known or strongly suspected to be resistant to the first-line drugs. If PZA cannot be used in the initial phase, the continuation phase must be increased to 7 months. The exception to these recommendations is central nervous system TB, for which the optimal length of therapy has not been established but some experts recommend 9 to 12 months. Most experts do recommend corticosteroids to be used as additional therapy for patients with TB meningitis and pericarditis. Consultation with a TB expert is recommended.
What are the four drugs that are included in the initial treatment regimen?
Four drugs— INH, RIF, PZA, and EMB — should be included in the initial treatment regimen until the results of drug-susceptibility tests are available. Each of the drugs in the initial regimen plays an important role. INH and RIF allow for short-course regimens with high cure rates. PZA has potent sterilizing activity, which allows further shortening of the regimen from 9 to 6 months. EMB helps to prevent the emergence of RIF resistance when primary INH resistance is present. If drug-susceptibility test results are known and the organisms are fully susceptible, EMB need not be included. For children whose clarity or sharpness of vision cannot be monitored, EMB is usually not recommended except when the risk of drug resistance is high or for children who have “adult-type” (upper lobe infiltration, cavity formation) TB disease.
How long is the TB continuation phase?
The continuation phase of treatment is given for either 4 or 7 months. The 4-month continuation phase should be used in patients with uncomplicated, noncavitary, drug-susceptible TB, if there is documented sputum conversion within the first 2 months. The 7-month continuation phase is recommended only for
What is the recommended treatment regimen based on?
The recommended treatment regimens are based, in large part, on evidence from clinical trials and are rated on the basis of a system developed by the U.S. Public Health Service (USPHS) and the Infectious Diseases Society of America (IDSA) (Table 6.3).
What are the drugs that treat TB?
Food and Drug Administration (FDA) for the treatment of TB disease (Table 6.2). In addition, the fluoroquinolones (levofloxacin, moxifloxacin, and gatifloxacin), although not approved by the FDA for TB disease, are commonly used to treat TB disease caused by drug-resistant organisms or for patients who are intolerant of some first-line drugs. Rifabutin, approved for use in preventing Mycobacterium avium complex disease in patients with HIV infection but not approved for TB disease, is useful for treating TB disease in patients concurrently taking drugs that interact with rifampin (e.g., certain antiretroviral drugs). Amikacin and kanamycin, nearly identical aminoglycoside drugs used in treating patients with TB disease caused by drug-resistant organisms, are not approved by the FDA for treatment of TB.
How long does it take to develop a TB control plan?
For each patient with newly diagnosed TB disease, a specific treatment and monitoring plan should be developed in collaboration with the local TB control program within 1 week of the presumptive diagnosis. This plan should include:
What is a drug resistant TB?
Drug resistant tuberculosis (TB) is defined as TB that is resistant to: 1.Fluoroquinolones. 2.Rifampin and isoniazid. 3.Amoxicillin. 4.Ceftriaxone. 2. Goals when treating tuberculosis include: 1.Completion of recommended therapy. 2.Negative purified protein derivative at the end of therapy.
How long is Isabella on treatment?
Isabella has confirmed tuberculosis and is placed on a 6-month treatment regimen. The 6-month
How to treat tuberculosis?
1. Patients are treated with a drug to which M. tuberculosis is sensitive. 2. Drugs need to be taken on a regular basis for a sufficient amount of time. 3. Treatment continues until the patient's purified protein derivative is negative. 4.
What is the best treatment for TB?
2. INH, ethambutol, kanamycin, and rifampin. 3. Treatment with at least two drugs to which the TB is susceptible. 4. Levofloxacin. 3. Treatment with at least two drugs to which the TB is susceptible. Lila is 24 weeks pregnant and has been diagnosed with tuberculosis (TB).
What is a drug resistant TB?
Drug resistant tuberculosis (TB) is defined as TB that is resistant to: 1.Fluoroquinolones. 2.Rifampin and isoniazid. 3.Amoxicillin. 4.Ceftriaxone. Click card to see definition 👆. Tap card to see definition 👆. 2.Rifampin and isoniazid. Click again to see term 👆.
How long does Isabella have to be on a treatment regimen?
All of the above. 2. Drugs need to be taken on a regular basis for a sufficient amount of time. Isabella has confirmed tuberculosis and is placed on a 6-month treatment regimen. The 6-month regimen consists of: 1.
Organization and Supervision of Treatment
Drugs in Current Use
- Currently, there are 10 drugs approved by the United States Food and Drug Administration (FDA) for treating tuberculosis (Table 9). In addition, the fluoroquinolones, although not approved by the FDA for tuberculosis, are used relatively commonly to treat tuberculosis caused by drug-resistant organisms or for patients who are intolerant of some of the first-line drugs. Rifabutin, approved for use in preventing Mycobacterium aviumcomple…
Principles of Antituberculosis Chemotherapy
- 4.1. Combination Chemotherapy The primary goals of antituberculosis chemotherapy are to kill tubercle bacilli rapidly, prevent the emergence of drug resistance, and eliminate persistent bacilli from the host's tissues to prevent relapse (1). To accomplish these goals, multiple antituberculosis drugs must be taken for a sufficiently long time. The t...
Recommended Treatment Regimens
- 5.1. Evidence-based Rating System To assist in making informed treatment decisions based on the most credible research results, evidence-based ratings have been assigned to the treatment recommendations (Table 1). The ratings system is the same as that used in the recommendations for treating latent tuberculosis infection, in which a letter indicating the strength of the recommendation, and a roman numeral indicating the quality of the e…
Practical Aspects of Treatment
- 6.1. Drug Administration The first-line antituberculosis medications should be administered together as single dose rather than in divided doses. A single dose leads to higher, and potentially more effective, peak serum concentrations. Administering a single daily dose also facilitates using DOT. Ingestion with food delays or moderately decreases the absorption of antituberculosis drugs (1). However, given the wide therapeutic margin …
Drug Interactions
- 7.1. Interactions Affecting Antituberculosis Drugs Drug--drug interactions can result in changes in the concentrations of one or both of the drugs involved. In the case of the antituberculosis drugs, there are relatively few interactions that substantially change the concentrations of the antituberculosis drugs; much more often the antituberculosis drugs cause clinically relevant changes in the concentrations of other drugs. The exceptions to …
Treatment in Special Situations
- 8.1. HIV Infection Treatment of tuberculosis in patients with HIV infection follows the same principles as treatment of HIV-uninfected patients. However, there are several important differences between patients with and without HIV infection. These differences include the potential for drug interactions, especially between the rifamycins and antiretroviral agents, paradoxical reactions that may be interpreted as clinical worsening, and th…
Management of Relapse, Treatment Failure, and Drug Resistance
- 9.1. Relapse Relapse refers to the circumstance in which a patient becomes and remains culture-negative while receiving antituberculosis drugs but, at some point after completion of therapy, either becomes culture-positive again or experiences clinical or radiographic deterioration consistent with active tuberculosis. In such patients vigorous efforts should be made to establish a diagnosis and to obtain microbiological confirmation of the relap…
Research Agenda For Tuberculosis Treatment
- 11.1. New Antituberculosis Drugs New antituberculosis drugs are needed for three reasons: to shorten or otherwise simplify treatment of tuberculosis caused by drug-susceptible organisms, to improve the treatment of patients with MDR tuberculosis, and to provide more effective and efficient treatment of latent tuberculosis infection (LTBI) (1). Although treatment regimens for drug-susceptible tuberculosis are effective, they must be a…