Nutrition
The standard of care for initiating treatment of TB disease is four-drug therapy. Treatment with a single drug can lead to the. development of a bacterial population resistant to that drug.
What are the treatment options for tuberculosis (TB) disease?
Treatment Category 2 was the regimen previously recommended by WHO for TB patients who required retreatment. For example due to treatment interruption or recurrence of disease. The preferred regimen was 2HRZES/1HRZE/5HRE (see the TB drugs page for the meaning of the abbreviations).
What is a Category 2 regimen for tuberculosis?
In the United States, the Food and Drug Administration (FDA) has approved fixed-dose combinations of isoniazid and rifampin (Rifamate®) and of isoniazid, rifampin, and pyrazinamide (Rifater®). Clinicians should become familiar with the management of TB disease using these fixed-dose combination drugs.
Which fixed-dose combination drugs are used in the treatment of tuberculosis (TB)?
Historically the greatest emphasis of TB control activities had been on the most infectious patients, those who had sputum smear positive TB, that is Categories 1 and 2. Smear negative TB patients were assigned third priority and MDR TB patients fourth priority.
What is the best category for TB control?
What does TB treatment include?
The most common treatment for active TB is isoniazid INH in combination with three other drugs—rifampin, pyrazinamide and ethambutol. You may begin to feel better only a few weeks after starting to take the drugs but treating TB takes much longer than other bacterial infections.
WHO tuberculosis treatment?
TB disease is curable. It is treated by standard 6 month course of 4 antibiotics. Common drugs include rifampicin and isoniazid. In some cases the TB bacteria does not respond to the standard drugs.
What are the 4 drug regimen given to patients with tuberculosis?
For initial empiric treatment of TB, start patients on a 4-drug regimen: isoniazid, rifampin, pyrazinamide, and either ethambutol or streptomycin. Once the TB isolate is known to be fully susceptible, ethambutol (or streptomycin, if it is used as a fourth drug) can be discontinued.
What is first line treatment for TB?
Of the approved drugs, isoniazid (INH), rifampin (RIF), ethambutol (EMB), and pyrazinamide (PZA) are considered first-line anti-TB drugs and form the core of standard treatment regimens (Figure 6.4) (Table 6.2).
WHO TB treatment categories?
The standardized regimens for anti-TB treatment recommended by WHO include five essential medicines designated as “first line”: isoniazid (H), rifampicin (R), pyrazinamide (Z), ethambutol (E) and streptomycin (S). Table 2.1 shows the recommended doses for adults and children.
What are 3 drugs for TB?
Rifampin (RIF),Isoniazid (INH),Pyrazinamide (PZA), and.Ethambutol (EMB)
What is the triple treatment for TB?
The commanding and lasting outcome: “triple therapy,” which included oral isoniazid together with PAS for 18 to 24 months, plus intramuscular streptomycin for the first 6 months (29). All together, “triple therapy” remained the standard treatment for all forms of tuberculosis for nearly 15 years (21).
How long does ethambutol last?
If you have drug-resistant TB, a combination of antibiotics called fluoroquinolones and injectable medications, such as amikacin or capreomycin (Capastat), are generally used for 20 to 30 months. Some types of TB are developing resistance to these medications as well.
What test is used to test for tuberculosis?
The most commonly used diagnostic tool for tuberculosis is a skin test, though blood tests are becoming more commonplace. A small amount of a substance called tuberculin is injected just ...
What is the test for TB?
Sputum tests. If your chest X-ray shows signs of tuberculosis, your doctor might take samples of your sputum — the mucus that comes up when you cough. The samples are tested for TB bacteria. Sputum samples can also be used to test for drug-resistant strains of TB.
What to do when you make an appointment?
What you can do. When you make the appointment, ask if there's anything you need to do in advance. Make a list of: Your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment, and when they began.
What is DOT therapy?
A program called directly observed therapy (DOT) can help people stick to their treatment regimen. A health care worker gives you your medication so that you don't have to remember to take it on your own.
What to do if you have a positive skin test?
If you've had a positive skin test, your doctor is likely to order a chest X-ray or a CT scan. This might show white spots in your lungs where your immune system has walled off TB bacteria, or it might reveal changes in your lungs caused by active tuberculosis.
How does physical health affect mental health?
Your physical health can affect your mental health. Denial, anger and frustration are normal when you must deal with something as challenging as tuberculosis. Talking to someone such as a therapist might help you develop coping strategies.
What is 6HE in chemo?
In the continuation phase, a self-administered regimen comprising daily treatment with six months of isoniazid and ethambutol (6HE) is an option if adherence to treatment with isoniazid and rifampicin (HR) cannot be ensured; for example, in mobile populations and for patients with very limited access to health care. However, in a comparative international multicentre clinical trial, 6HE was found to be inferior to the 4HR continuation phase regimen, with a significantly higher unfavourable outcome (failure or relapse) at 12 months after the end of chemotherapy. The proportions with unfavourable outcomes were 10% for the 2HRZE/6HE regimen (initial and continuation phases administered daily), 14% for 2(HRZE)3/6HE (initial phase administered three times weekly) and 5% for 2HRZE/4HR.
What are the first line antibiotics for TB?
The standardized regimens for anti-TB treatment recommended by WHO include five essential medicines designated as “first line”: isoniazid (H), rifampicin (R), pyrazinamide (Z), ethambutol (E) and streptomycin (S). Table 2.1shows the recommended doses for adults and children.
How long does TB treatment last?
For treatment of new cases of pulmonary or extrapulmonary TB, WHO recommends a standardized regimen consisting of two phases. The initial (intensive) phase uses four drugs (rifampicin, isoniazid, pyrazinamide and ethambutol) administered for two months. This is followed by a continuation phase with two drugs (rifampicin and isoniazid) for four months or, exceptionally, with two drugs (isoniazid and ethambutol) for six months when adherence to treatment with rifampicin cannot be ensured (Table 2.2).
What is the first line of anti-TB medication?
The standardized regimens for anti-TB treatment recommended by WHO include five essential medicines designated as “first line”: is oniazid (H), rifampicin (R), pyrazinamide (Z), ethambutol (E) and streptomycin (S). Table 2.1 shows the recommended doses for adults and children.
How long is rifampicin in the initial phase?
five drugs in the initial phase(rifampicin, isoniazid, pyrazinamide, ethambutol and streptomycin). The initial phase is administered for three months, with all five drugs administered for the first two months. Streptomycin is discontinued after two months, and the four remaining drugs are given in the third month. WHO recommends daily administration of drugs in the initial phase;
How long is the continuation phase of rifampicin?
three drugs in the continuation phase(rifampicin, isoniazid and ethambutol). The continuation phase is administered for five months, daily or intermittently, three times a week.
What is TB diagnostic category IV?
Patients in whom drug-resi stant TB is diagnosed and who require treatment with second-line drugs are classified as WHO TB diagnostic Category IV and require regimens termed “Category IV regimens”. This section provides guidance on the strategy options, including standardized, empirical and individualized approaches, for treating drug-resistant TB. A description of drugs, doses and coding of treatment regimens is provided in Guidelines for the programmatic management of drug-resistant tuberculosis.
What are the new drugs that have been evaluated for tuberculosis?
These include amikacin, quinolones, rifamycin derivatives, clofazimine, and beta-lactams (9). None of these agents has been tested in multidrug regimens for treating tuberculosis; however, the recent increase in the occurrence of multidrug- resistant tuberculosis may create more situations where the use of these drugs must be considered. None of these drugs has been evaluated in well- designed, randomized trials for tuberculosis treatment or prophylaxis, and they should not be used to replace any of the previously recommended drugs until efficacy is established. Among the new drugs that have been studied as antituberculosis agents, the ones that are discussed subsequently include only those that are licensed or those that are available through an investigational new drug (IND) request, in the United States. Appropriate doses and intervals for the use of these drugs for tuberculosis have not been established. When available, doses are provided. If these drugs are used in infants and children, appropriate adjustments should be made in consultation with tuberculosis experts.
How to diagnose tuberculosis?
In all adults with radiographic abnormalities consistent with tuberculosis, vigorous efforts should be made to establish a microbiologic diagnosis . These efforts should include induction of sputum by inhalation of hypertonic saline. Bronchoscopy with appropriate biopsies and bronchoalveolar lavage should be considered for patients unable to produce a satisfactory sputum specimen. If no other diagnosis can be established, presumptive treatment for tuberculosis may be indicated. In such adults, the major indicators of response to therapy are the chest radiograph and clinical evaluation. The intervals at which chest films should be repeated will depend on the clinical circumstances and the differential diagnosis being considered. Failure of the radiograph to improve after 3 mo of chemotherapy is strongly suggestive that the abnormality is the result of either previous (not current) tuberculosis or another process. If the tuberculin reaction is positive and other diagnoses have been excluded, isoniazid and rifampin can be continued for a total of 4 mo. In children with suspect tuberculosis, microbiologic data can be gained from early morning gastric aspirates or urine. In complicated cases or severely ill children, bronchoalveolar lavage should be considered. An aggressive diagnostic approach in children with HIV infection or pneumonia that is unresponsive to standard treatment should be taken. Specimens for smear, culture, and susceptibility tests should be collected from all children for whom culture and susceptibility information is not available in their adult contact whenever possible.
What is the best treatment for HIV?
A 6-mo regimen consisting of isoniazid, rifampin, and pyrazinamide given for 2 mo followed by isoniazid and rifampin for 4 mo is the preferred treatment for patients with fully susceptible organisms who adhere to treatment. Ethambutol (or streptomycin in children too young to be monitored for visual acuity) should be included in the initial regimen until the results of drug susceptibility studies are available, unless there is little possibility of drug resistance (i.e., there is less than 4% primary resistance to isoniazid in the community, and the patient has had no previous treatment with antituberculosis medications, is not from a country with a high prevalence of drug resistance, and has no known exposure to a drug-resistant case). This four-drug, 6-mo regimen is effective even when the infecting organism is resistant to INH. This recommendation applies to both HIV-infected and uninfected persons. However, in the presence of HIV infection it is critically important to assess the clinical and bacteriologic response. If there is evidence of a slow or suboptimal response, therapy should be prolonged as judged on a case by case basis.
How much therapy is needed for extrapulmonary tuberculosis?
Extrapulmonary tuberculosis should be managed according to the principles and with the drug regimens outlined for pulmonary tuberculosis, except for children who have miliary tuberculosis, bone/joint tuberculosis, or tuberculous meningitis who should receive a minimum of 12 mo of therapy.
Why is preventive therapy important?
Priorities for preventive therapy take into consideration the risk of developing tuberculosis compared with the risk of isoniazid toxic ity (53). Recommendations for the use of isoniazid are based on a comparison of the risk of hepatic injury during the period of treatment with the potential lifelong benefit of preventive therapy. Also of importance is the benefit to society derived from preventive therapy because prevention of tuberculosis precludes the spread of new infection.
What is the target of fluoroquinolones?
A number of fluoroquinolones have been developed that show in vitro activity against M. tuberculosis. The target of the quinolones is a DNA gyrase. Ofloxacin and ciprofloxacin are compounds in this family that are licensed for use in the United States. Neither of these drugs is licensed for the treatment of tuberculosis.
Why is it important to use fixed drug combinations?
The use of fixed drug combinations may enhance patient adherence and may reduce the risk of inappropriate monotherapy, and it may prevent the development of secondary drug resistance. For this reason, the use of such fixed drug combinations is strongly encouraged in adults.
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 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).
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 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:
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.
Which category of TB is the most infectious?
Historically the greatest emphasis of TB control activities had been on the most infectious patients, those who had sputum smear positive TB, that is Categories 1 and 2. Smear negative TB patients were assigned third priority and MDR TB patients fourth priority.
When was the last time the WHO TB guidelines were published?
The third edition of the WHO TB treatment guidelines published in 2003 was the last to refer to Categories. The fourth edition of the WHO Treatment of Tuberculosis Guidelines published in 2010, abandoned reference to Categories 1-4 which had previously been used to prioritize patients for treatment.
What category of patients lost the correlation between treatment regimen and patient group?
Over a number of years the original one to one correlation between patient group and treatment regimen was lost as Categories 1-4 were redefined with the increased availability of drug susceptibility testing. Also the same treatment regimen came to be recommended for patients in Categories 1 and 3.
What is the problem with category 2 treatment?
A major problem with the Treatment category 2 regimen was that Streptomycin was being added to a regimen which a patient had previously been treated with. This goes against the principle of never adding one single drug to a failing regimen.
What is treatment category?
Treatment category is an historical term from the earlier days of drug treatment for TB.
What is the Stop TB Strategy?
The Stop TB Strategy had an emphasis on universal access for all people with TB to high quality patient centred treatment. The Patients Charter for TB Care specified that all TB patients have "the right to free and equitable access to TB care, from diagnosis through treatment completion."
Is streptomycin toxic to TB?
The drug Streptomycin which has toxic side effects such as causing deafness, was being given to patients who might well have drug susceptible TB. And Streptomycin was also potentially being given to patients who needed a properly defined MDR-TB regimen.
What is the most recent common ancestor of the Mycobacterium tuberculosis complex?
Origins. Scientific work investigating the evolutionary origins of the Mycobacterium tuberculosis complex has concluded that the most recent common ancestor of the complex was a human-specific pathogen, which underwent a population bottleneck.
How did the royal touch work?
Initially, the touching ceremony was an informal process. Sickly individuals could petition the court for a royal touch and the touch would be performed at the King's earliest convenience. At times, the King of France would touch afflicted subjects during his royal walkabout. The rapid spread of tuberculosis across France and England, however, necessitated a more formal and efficient touching process. By the time of Louis XIV of France, placards indicating the days and times the King would be available for royal touches were posted regularly; sums of money were doled out as charitable support. In England, the process was extremely formal and efficient. As late as 1633, the Book of Common Prayer of the Anglican Church contained a Royal Touch ceremony. The monarch (king or queen), sitting upon a canopied throne, touched the afflicted individual, and presented that individual with a coin – usually an Angel, a gold coin the value of which varied from about 6 shillings to about 10 shillings – by pressing it against the afflicted's neck.
What disease did Rojas suffer from?
Rojas was suffering from tuberculosis when he painted this. Here he depicts the social aspect of the disease, and its relation with living conditions at the close of the 19th century. Throughout history, the disease tuberculosis has been variously known as consumption, phthisis, and the White Plague. It is generally accepted that the causative ...
How did TB spread?
In South America, reports of a study in August 2014 revealed that TB had likely been spread via seals that contracted it on beaches of Africa, from humans via domesticated animals, and carried it across the Atlantic. A team at the University of Tübingen analyzed tuberculosis DNA in 1,000-year-old skeletons of the Chiribaya culture in southern Peru; so much genetic material was recovered that they could reconstruct the genome. They learned that this TB strain was related most closely to a form found only in seals. In South America, it was likely contracted first by hunters who handled contaminated meat. This TB is a different strain from that prevalent today in the Americas, which is more closely related to a later Eurasian strain.
How old is tuberculosis?
In 2014, results of a new DNA study of a tuberculosis genome reconstructed from remains in southern Peru suggest that human tuberculosis is less than 6,000 years old.
Why is TB called the robber of youth?
At the time, tuberculosis was called the robber of youth, because the disease had higher death rate among young people. Other names included the Great White Plague and the White Death, where the "white" was due to the extreme anaemic pallor of those infected. In addition, TB has been called by many as the "Captain of All These Men of Death".
What is the name of the disease that was first described in the Atharvaveda?
The oldest of them ( Rigveda, 1500 BC) calls the disease yaksma. The Atharvaveda calls it balasa. It is in the Atharvaveda that the first description of scrofula is given. The Sushruta Samhita, written around 600 BC, recommends that the disease be treated with breast milk, various meats, alcohol and rest.
