Treatment of Drug Susceptible Pulmonary Tuberculosis

Abstract

Tuberculosis (TB) remains a major global health problem, and the incidence of TB cases has not significantly decreased over the past decade in Korea. The standard short course regimen is highly effective against TB, but requires multiple TB-specific drugs and a long treatment duration. Recent studies using late-generation fluoroquinolones and/or high-dose rifapentine-containing regimens to shorten the duration of TB treatment showed negative results. Extending the treatment duration may be considered in patients with cavitation on the initial chest radiograph and positivity in sputum culture at 2 months of treatment for preventing TB relapse. Current evidence does not support the use of fixed-dose combinations compared to separate drugs for the purpose of improving treatment outcomes. All patients receiving TB treatment should be monitored regularly for response to therapy, facilitation of treatment completion, and management of adverse drug reactions. Mild adverse effects can be managed with symptomatic therapy and changing the timing of the drug administration, but severe adverse effects require a discontinuation of the offending drugs.

The potassium transporter KdpA affects persister formation by regulating ATP levels in Mycobacterium marinum

“…The survival of M. tuberculosis persisters in the presence of antibiotics is thought to be one of the principle reasons why anti-tuberculosis therapy must be given for at least six months to obtain 90-95% cure rates [1,2]. To learn more about the mechanisms responsible for persistence in mycobacteria, we screened an M. marinum library of transposon insertions to find mutants with an impaired ability to form persisters in the presence of rifampicin.…”

“…Tuberculosis (TB), caused by Mycobacterium tuberculosis, kills more people than any other single infectious disease. Drug regimens can cure 90-95% of patients with drug susceptible TB, but only if the drugs are taken for at least six months [1]. One factor thought to contribute to the need for prolonged therapy is the presence of "persisters"bacilli that are not rapidly killed by the antibiotics currently used [2].…”

Estimated rates of recurrence, cure, and treatment abandonment in patients with pulmonary tuberculosis treated with a four-drug fixed-dose combination regimen at a tertiary health care facility in the city of Rio de Janeiro, Brazil

“…Adverse effects were classified as minor and major. Major adverse effects, namely, hepatitis, rifampin-induced thrombocytopenia, hemolytic anemia, acute renal failure, thrombotic thrombocytopenic purpura, ethambutol-induced optic neuritis, and pyrazinamide-induced acute gouty arthritis, require discontinuation of the offending drug and a change in the initial regimen 6 . Minor adverse effects include skin rash, acne, itching, arthralgia, and mild gastrointestinal symptoms, such as nausea, vomiting, loss of appetite, and abdominal pain; in cases of patients exhibiting these effects, it is usually not necessary to change treatment, and patient management consists of symptomatic therapy and a change in the administration schedule 6 …”

Recommendations for Optimizing Tuberculosis Treatment: Therapeutic Drug Monitoring, Pharmacogenetics, and Nutritional Status Considerations

“…The standard treatment for TB comprises an intensive phase with isoniazid and rifampicin, as well as pyrazinamide and ethambutol for two months, followed by a continuation phase that comprises the concomitant use of isoniazid and rifampicin for further four months [234]. Although the standard 6-month treatment regimen is highly effective for drug-susceptible TB, the use of multiple drugs over long periods of time can cause frequent adverse drug reactions [56].…”