tb treatment outcomes how long

What are the phases of TB treatment?

5 rows · The 6- to 9-month RIPE TB treatment regimens consist of. R ifampin (RIF), I soniazid (INH), P ...

What drugs treat TB?

TB Treatment & Case Outcomes. Successful therapy completion for TB patients is a major performance indicator for TB programs. Among patients during 2016 who were alive at diagnosis, 87.2% had completed TB treatment successfully. Data collected by date and reason therapy was stopped (e.g., the patient completed therapy, or the patient died) were ...

What is the current treatment for tuberculosis?

TB germs die very slowly. For the treatment of latent TB infection, it takes at least 3 months (and possibly longer depending on which medications you are on) to kill the TB germs. For TB disease, it takes even longer and at least 6 months for the medicines to kill all the TB germs.

How to cure tuberculosis?

Page. TB disease must be treated for at least 6 to 9 months. In some cases, treatment can last much longer, for example, 18 to 24 months or longer to treat multidrug-resistant TB (MDR TB). Regimens for treating TB have an initial phase of 2 months, followed by a continuation phase of either 4 or 7 months.

How long does TB take to resolve?

How long will TB treatment last?

What are treatment outcomes for tuberculosis?

Can TB come back after full treatment?

Can TB come back after 5 years?

Can lungs heal after TB?

What is the likely outcome of tuberculosis?

What is treatment outcome?

What is the fastest way to cure TB?

Does TB shorten your life?

Does TB stay in your body forever?

Can TB recur after 10 years?

How long does it take to cure TB?

Most people with TB disease will need to take TB medicine for at least 6 months to be cured.

How many people with LTBI will develop TB?

While not everyone with LTBI will develop TB disease, about 5–10% will develop TB disease over their lifetimes if not treated. Progression from untreated LTBI to TB disease is estimated to account for approximately 80% of U.S. TB cases. Some people who have LTBI are more likely to develop TB disease than others.

What does a negative TB test mean?

A negative TB blood test means that your blood did not react to the test and that you likely do not have TB infection. TB blood tests are the recommended TB test for: People who have received the bacille Calmette–Guérin (BCG) TB vaccine.

How does TB spread?

The TB germs are spread into the air when a person with infectious TB disease of the lungs or throat coughs, speaks, or sings. People nearby may breathe in these TB germs and become infected. When a person breathes in TB germs, the TB germs can settle in the lungs and begin to grow.

What is the cause of TB?

Tuberculosis (TB) is caused by bacteria called Mycobacterium tuberculosis (M. tuberculosis). The bacteria, or germ, usually attack the lungs. TB germs can attack any part of the body, such as the kidney, spine, or brain. There is good news. People with TB can be treated if they seek medical help.

What does it mean when you have a positive TB test?

May feel sick and may have symptoms such as a cough, fever, and/or weight loss. Usually has a positive TB skin test or TB blood test indicating TB infection. Usually has a positive TB skin test or TB blood test indicating TB infection. Has a normal chest x-ray and a negative sputum smear.

Where are people born with TB?

You were born in or frequently travel to countries where TB disease is common, including Mexico, the Philippines, Vietnam, India, China, Haiti, and Guatemala, and other countries where TB is common.

How long does TB treatment last?

TB disease must be treated for at least 6 to 9 months. In some cases, treatment can last much longer, for example, 18 to 24 months or longer to treat multidrug-resistant TB (MDR TB).

Can TB reoccur?

If treatment is not continued for a long enough time, the remaining bacilli may continue to grow, causing TB disease to re-occur.

How long is TB treatment?

Given that TB treatment is long (6 to 18 months or more), interim outcomes provide early indicators of programme results. Table 17.1 provides a summary on interim outcomes.

What is outcome assignment in TB?

These are: – Outcome assignment is standardized, as to permit comparisons across clinicians, time and sites. – Outcome assignment relies heavily, but not exclusively, on bacteriologic endpoints (smear or culture 1 ).

What should a clinic decide on TB treatment?

Clinicians should choose the appropriate treatment regimen based on drug susceptibility results of the presumed source case (if known), coexisting medical conditions (e.g., HIV. ), and potential for drug-drug interactions. Consultation with a TB expert is advised if the known source of TB infection has drug-resistant TB.

What is the name of the drug that is used to treat TB?

Isoniazid (INH) Rifapentine (RPT) Rifampin (RIF) These medications are used on their own or in combination, as shown in the table below. CDC and the National Tuberculosis Controllers Association (NTCA) preferentially recommend short-course, rifamycin-based, 3- or 4-month latent TB infection treatment regimens over 6- or 9-month isoniazid ...

Is 6H a good treatment for TB?

If short-course treatment regimens are not a feasible or an available option, 6H and 9H are alternative, effective latent TB infection treatment regimens. Although effective, 6H and 9H have higher toxicity risk and lower treatment completion rates than most short-term treatment regimens.

What is the resistance rate of anti-TB drugs?

Table 2 shows the rates of resistance of all patients to anti-TB drugs. Strains from MDR-TB patients exhibited additional resistance to PZA (40.3%), any FQ (26.7%), any SLID (21.6%), PTO (17.0%), and CS (10.2%). Pre-XDR- and XDR-TB patients accounted for 36.9% of all patients. There was no difference in the resistance rates of individual anti-TB drugs or the number of resistant drugs in the pre- and post-PPM periods. However, the proportion of pre-XDR-TB patients exhibiting SLID resistance was lower in the post-PPM period.

What is the most common anti-TB drug?

The most common anti-TB drugs used in all patients were FQs (OFX, LFX, or MFX; 86.4%), followed by CS (84.7%), injectables (SM, AMK, or KM; 81.3%), PTO (80.1%), and PZA (65.9%). Of all patients, 19.3%, 10.2%, and 8.5% were given LZD, DLM, and BDQ, respectively. Ten patients (5.7%) underwent surgery (Table 3). PZA, AMK, LZD, clofazimine (CFZ), BDQ, and DLM were more commonly prescribed in the postPPM period. The numbers of drugs used for ≥1 month did not differ between the two periods. However, the total treatment duration was shorter in the post-PPM period (Table 3).

What is a MDR TB?

MDR-TB was defined as TB resistant to both isoniazid (INH) and RIF; XDR-TB as MDR-TB further resistant to any fluoroquinolone (FQ) and at least one of the three second-line injectable drugs (SLIDs; kanamycin [KM], amikacin [AMK], and capreomycin [CM]); and pre-XDR-TB as MDR-TB further resistant to either an FQ or any SLID but not both [13]. The patients were classified into two groups by treatment history: new patients who had never been treated or who had taken anti-TB drugs for <1 month, and previously treated patients who had received anti-TB drugs for ≥1 month [13]. Treatment outcomes were categorized in accordance with the WHO definitions as follows: cured, treatment completed, treatment failed, died, lost to follow-up, or not evaluated [13]. Treatment success was defined as the sum of cured and treatment completed. All other treatment outcomes were considered unfavorable.

Which country has the highest TB rate?

Despite national efforts to control TB, South Korea has the highest TB incidence of all member countries of the Organization for Economic Co-operation and Development, with a total TB incidence of 65.9/100,000 in 2018 [4,5]. In 2018, 3.2% of new cases and 9.2% of previously treated cases had multidrug-resistant (MDR)- or rifampicin-resistant (RR)-TB; 618 patients with MDR-TB were recorded by the Korean National TB Surveillance System [3,5]. The treatment success rates of MDR/RR-and XDR-TB in 2016 were only 66 and 58%, respectively [3].

Is the success rate of MDR-TB higher in the post-PPM period than in the pre-P

The treatment success rate in MDR-TB patients was higher in the post-PPM period than in the pre-PPM period, particularly because of the low rate of loss to follow-up. To ensure comprehensive patient-centered PPM in South Korea, investment and other support must be adequate.

Is MDR TB a global problem?

Multidrug-resistant tuberculosis (MDR-TB) constitutes a major global obstacle when seeking to eliminate tuberculosis (TB), and is also a significant public health problem [1]. Treatment is challenging; long-term use of second-line anti-TB drugs that are more toxic and less effective than first-line drugs is essential [2]. Treatment outcomes remain unsatisfactory. The proportion of MDR-TB patients in a 2016 global cohort who successfully completed treatment was only 56% [3]. The treatment success rate of extensively drug-resistant (XDR)-TB patients is very poor; only 39% of such patients successfully completed treatment in 2016 [3].

How many people have tuberculosis each year?

Tuberculosis (TB) affects 8.7 million people each year; while 1 in every 3 human beings on earth has been exposed to Mycobacterium tuberculosisand has latent tuberculosis infection [1]. The vast majority of research on tuberculosis has focused on pulmonary disease, with efforts to shorten therapy duration. Meanwhile, the rate of “extra-pulmonary” tuberculosis (EPTB) has increased from one in every 25 TB patients in 1995 to about one in every five TB patients in 2002, and one in every three TB patients in 2011 [2,3]. More than 50% of HIV-infected patients with tuberculosis present with EPTB. Patients using tumor necrosis factor-α inhibitors for autoimmune diseases have a 4-5 fold increase in the rate of active tuberculosis compared with non-users, and have EPTB rates similar to those with AIDS [4]. The recommended treatment for drug-susceptible EPTB is with isoniazid, rifampin, ethambutol and pyrazinamide for 6 months, with the exception of tuberculous meningitis which is treated with 9 to 12 months of therapy [5]. In general, extra-pulmonary tuberculosis in adult patients has been lumped aside in a wastebasket category. Meningitis is a notable exception [6-10]. Dutt, Moers and Stead studied the outcomes over an average period of 3 years post treatment in 219 EPTB the early 1980s [11]. However, this cohort of patients was treated with a regimen of isoniazid and rifampin alone, not the standard four drug regimen used today. In a second study, Kwara et al examined data on 126 patients with EPTB at the dawn of the AIDS pandemic, and found that the short-term mortality during treatment of EPTB was associated with HIV-infection, meningeal tuberculosis and disseminated disease [12]. Long-term outcomes were not reported. Thus, the long-term outcome in EPTB patients “adequately treated” with the current standard regimen is unknown, so that it is unclear if standard short course therapy is effective in reducing long-term mortality. We have developed methods to use the Texas electronic database to examine long-term outcomes such as death in tuberculosis patients [6]. This study is focused on the evaluation of long-term outcomes in patients with EPTB, and the demographic and therapy factors predictive of poor long-term outcome.

Why is TB associated with different mortality?

It is unclear why TB infection in different organs is associated with different mortality. This could reflect the impact of tuberculosis damage on different organs. An example are the cerebrovascular accidents in tuberculous meningitis [38,39]. Alternatively, this could reflect the differential penetration of antibiotics into different anatomic sites. Poor penetration would reduce both peak concentration and 24 hr area under the concentration-time curve (AUC) to minimum inhibitory concentration ratios, which are known to correlate with microbial kill and suppression of acquired drug resistance in pre-clinical hollow fiber system of tuberculosis studies and in patients [21,40-44]. As an example, in tuberculous meningitis, the blood-brain barrier variably and unpredictably decreases drug levels depending on compartment and drug selected, with such drugs as rifampin achieving only 2-20% those achieved in the serum, while isoniazid AUC is 80% that in serum [10,45,46]. Indeed, when drugs that penetrate well into the meninges such as quinolones are included, or rifampin’s dose is increased so that the AUC is increased, tuberculous meningitis patients have decreased mortality [8,10]. Similarly, in bone/joint disease, the percentage of drug in foci in sclerotic bone is 0-8% for rifampin, 0-6% for pyrazinamide, and 0-23% for isoniazid [47]. These drug-concentration scenarios are known to lead to acquired drug resistance and poor efficacy [21,48]. Finally, it could be that for some syndromes such as meningitis, the M. tuberculosisgenotypes that preferentially cause such disease are more difficult to kill and have a higher propensity to fail and develop drug resistance [49-52].

How old is too old to report tuberculosis in Texas?

We excluded persons ≤18 years-old, since pediatric tuberculosis disease is different from that in adults [16]. Texas has 254 counties, which report to the Texas Department of State Health Services. The Texas Department of State Health Services requires health care workers to report an active tuberculosis case within one working day and latent tuberculosis within one week to the local county health authority. All tuberculosis patients in Texas are treated using CDC recommended regimens and the directly observed therapy strategy (DOTS) [5]. All latent tuberculosis patients are offered free isoniazid treatments for at least six months [17].

What is the relationship between treatment duration and mortality?

The relationship between treatment duration and mortality is a “V” shaped curve. CART analysis was used to identify the treatment duration thresholds associated with long-term outcome within each EPTB syndrome. For all disease syndromes, mortality decreased with longer treatment duration until a nadir, which was the treatment duration associated with lowest proportion of patients with adverse long-term outcomes. Thereafter, mortality increased with longer duration of therapy.

What is an EPTB?

Tuberculosis case definitions and classification as EPTB were based on generic definitions included in the Report of Verified Case of Tuberculosis manual. An episode of microbiologically proven tuberculosis disease is defined as: (1) isolation of M. tuberculosisby culture from a clinical specimen, or (2) demonstration of M. tuberculosisin a clinical specimen by nucleic acid amplification test, or (3) demonstration of acid-fast bacilli in a clinical specimen when a culture has not been or cannot be obtained or is falsely negative or contaminated. Patients were considered to have EPTB if radiographic imaging or clinical samples taken from disease sites were consistent with tuberculosis, and/or if clinical assessment was highly suggestive of tuberculosis. EPTB comprised any extra-pulmonary disease site: lymphatic, bone and/or joint, genitourinary, meningeal, peritoneal, and unclassified EPTB sites listed as “other” in the Report of Verified Case of Tuberculosis. For the purpose of this study, we excluded patients who had both EPTB and pulmonary tuberculosis, including any intra-thoracic disease or pleural tuberculosis or miliary tuberculosis. Previous anti-tuberculosis therapy refers to patients who reported receipt of treatment for tuberculosis in the medical history.

When was the EPTB cohort study conducted?

We performed a retrospective cohort study in which all patients treated for EPTB between January 1st, 2000, and December 31st, 2005, had records examined for clinical and epidemiological factors. The main long-term outcome, which is all-cause mortality by December 31, 2011, was then established for each patient. We compared all-cause mortality rates between EPTB and of age-adjusted Texas population as well as of another comparable cohort of patients with latent tuberculosis treated during the same period [13,14]. The latent tuberculosis patient cohort was previously reported by us [13,14], while the Texas age-adjusted all-cause population mortality rates are published annually by the Centers for Disease Control and Prevention (CDC) [15].

What is the primary endpoint of interest in the study of Tuberculosis?

All-cause mortality was chosen as the primary endpoint of interest since the exact causes of death were not ascertained for each patient. The dates of when patients started and stopped therapy are captured in the Report of Verified Case of Tuberculosis, and the duration of therapy computed using these dates for all patients in whom therapy was not interrupted, and rounded to the nearest month. Based on proposals in the published literature, we examined the following categorized therapy durations defined a priori: <6-months, 6-months, 6-10 months and > -10 months [5,11,12]. In addition, we took an unbiased approach, specified no categories, and identified cut-off levels based on the data by employing classification and regression analysis (CART). Additionally, based on patients’ case completion reports on follow-up, comparisons were made between patient groups using “reasons therapy stopped”.