Tuberculosis (TB) Facts (cont.)
Charles Patrick Davis, MD, PhD
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Jerry R. Balentine, DO, FACEP
Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
In this Article
- Tuberculosis (TB) facts
- What is tuberculosis?
- Are there different types of tuberculosis?
- What causes tuberculosis?
- What are risk factors for tuberculosis?
- What are tuberculosis symptoms and signs?
- How do physicians diagnose tuberculosis?
- What is the treatment for tuberculosis?
- What are complications of tuberculosis?
- What is the prognosis of tuberculosis?
- How can people prevent tuberculosis?
What is the treatment for tuberculosis?
The treatment for TB depends on the type of TB infection and drug sensitivity of the mycobacteria. For latent TB, three anti-TB drugs are used in four different recommended schedules. The drugs are isoniazid (INH), rifampin (RIF; Rifadin), and rifapentine (RPT; Priftin) and the 2013 CDC's four recommended schedules are below and are chosen by the treating doctor based on the patients overall health and type of TB the patient was likely exposed to.
|Isoniazid and Rifapentine||3 months||Once weekly||12|
|Table reproduced from the CDC; http://www.cdc.gov/tb/topic/treatment/default.htm|
First-line drugs used to treat active TB are INH, RIF, ethambutol (EMB; Myambutol), and pyrazinamide. The CDC offers a guide for the basic treatment schedules for active TB as follows:
|Preferred Regimen||Alternative Regimen||Alternative Regimen|
Daily INH, RIF, PZA, and EMB* for 56 doses (8 weeks)
Daily INH, RIF, PZA, and EMB* for 14 doses (2 weeks), then twice weekly for 12 doses (6 weeks)
Thrice-weekly INH, RIF, PZA, and EMB* for 24 doses (8 weeks)
Daily INH and RIF for 126 doses (18 weeks)
twice-weekly INH and RIF for 36 doses (18 weeks)
Twice-weekly INH and RIF for 36 doses (18 weeks)
Thrice-weekly INH and RIF for 54 doses (18 weeks)
|*EMB can be discontinued if drug susceptibility studies demonstrate susceptibility to first-line drugs; Table reproduced from http://www.cdc.gov/tb/topic/treatment/tbdisease.htm#2|
Treatment of drug-resistant TB can be difficult. Patients with these infections are recommended by the CDC to involve infectious-disease specialists as there are multiple approaches that involve other anti-TB drugs and variable treatment schedules that can be used. In addition, there are new drugs and treatment schedules being developed and approved by the FDA. The infectious-disease consultant may be aware of these newest treatments that may benefit specific patients. For example, bedaquiline (Sirturo) has been approved for treatment of MDR TB.
In some patients, the lung destruction may be severe and the only treatment left may be surgical resection of the diseased lung tissue.
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