Treating tuberculosis: what drugs, for how long?

Article Abstract:

Tuberculosis (TB), an infectious disease caused by the tubercle bacillus, is characterized by the formation of abnormal growths called tubercles, abscesses, and fiber-like tissue, as well as calcium deposits and tissue deterioration. The infection commonly affects the respiratory system, but may also involve other body organs. The development of effective drugs for treating this disease and decreased incidence of TB have led people to believe that it is a minor health problem. However, with the increased prevalence of human immunodeficiency virus (HIV) infections, the incidence of TB has begun to rise. Recent research strongly indicates that TB can be treated effectively by an initial two-month daily drug regimen consisting of the antituberculosis agents rifampin, isoniazid, and pyrazinamide, followed by a four-month regimen of daily isoniazid and rifampin. Initial treatment with the first drug regimen may only last for two to four weeks if streptomycin is included. Alternatively, rifampin and isoniazid can be given for nine months. These drug regimens are effective in persons with primary TB, patients under 18 years, and when TB affects sites other than the lungs. With the exception of streptomycin, antituberculous drugs can be used during pregnancy. Antituberculous agents can also be taken by alcoholic patients. Resistance of bacteria to isoniazid can be managed by the addition of ethambutol. Patients with both TB and HIV infection should be treated for 9 to 12 months. (Consumer Summary produced by Reliance Medical Information, Inc.)

Demographic aspects, HIV (Viruses), HIV, editorial

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A 62-dose, 6-month therapy for pulmonary and extrapulmonary tuberculosis

Article Abstract:

Tuberculosis (TB) is an infectious disease caused by the tubercle bacillus. It is characterized by the formation of abnormal growths called tubercles, abscesses, fiber-like tissue, tissue deterioration, and calcium deposition in affected organs. The infection commonly affects the respiratory system, but may also involve other body organs. The effectiveness and toxicity of a drug regimen for treating TB was evaluated. The regimen consisted of daily administration of isoniazid, rifampin, pyrazinamide, and streptomycin for two weeks, followed by higher doses of these antituberculosis agents twice weekly for six weeks, and the administration of isoniazid and rifampin twice weekly for the last 18 weeks of TB drug therapy. A total of 62 doses of medication was given over a 26-week period. Of 125 patients with TB, 101 had TB of the lung, 7 had TB affecting the lung and other sites, and 17 had TB in organs other than the lung. Seventy-one patients had a history of alcoholism. The infection cleared in all of the TB patients within 20 weeks. Two patients experienced relapses of TB 6 and 56 months, respectively, after completing therapy. Adverse drug effects included hyperuricemia or high blood levels of uric acid due to pyrazinamide, increased levels of the enzymes aspartate aminotransferase and alkaline phosphatase, skin disorders, nausea, and dizziness. The results demonstrate that the 62-dose, twice-weekly tuberculous treatment drug regimen is effective and safe. (Consumer Summary produced by Reliance Medical Information, Inc.)

Streptomycin

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USPHS tuberculosis short-course chemotherapy trial 21: effectiveness, toxicity, and acceptability: the report of final results

Article Abstract:

Tuberculosis (TB), an infectious disease caused by the tubercle bacillus, is characterized by the formation of abnormal growths called tubercles, abscesses, and fiber-like tissue, as well as calcium deposits and tissue deterioration. The infection commonly affects the respiratory system, but may also involve other body organs. Two drug regimens for treating TB were compared. In the six-month regimen, isoniazid, rifampin and pyrazinamide were taken daily for eight weeks, and, then, isoniazid and rifampin were taken daily for four months. In the second therapeutic plan, isoniazid and rifampin were taken daily for nine months. There were 617 patients with TB assigned to the six-month regimen, and 445 TB patients assigned to the nine-month program. The results demonstrate that patients on the six-month regimen improved more rapidly than patients on the nine-month regimen. Both groups had similar rates of adverse drug reactions. Patients on the six-month regimen had better compliance or better tolerance of drug therapy. Both groups had similar relapse rates two years after completing drug therapy. More patients successfully completed the six-month drug regimen than the nine-month drug regimen. The results show that the six-month drug regimen is similar in effectiveness, toxicity, and tolerance to the nine-month regimen for treating TB affecting the lungs. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Patient compliance

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