Treatment of tuberculosis: update 2010

Abstract

Currently, the standard short-course chemotherapy for tuberculosis comprises a 6-month regimen, with a four-drug intensive phase and a two-drug continuation phase. Alternative chemotherapy using more costly and toxic drugs, often for prolonged durations generally .18 months, is required for multidrug-resistant and extensively drug-resistant tuberculosis. Directly observed treatment, as part of a holistic care programme, is a cost-effective strategy to ensure high treatment success and curtail development of drug resistance in tuberculosis. New antituberculosis drugs are urgently needed to improve the present standard short-course and alternative chemotherapies, by shortening administration durations and increasing cure rates, through the greater potency of these agents. At the same time, the role of adjunctive surgery for drug-resistant tuberculosis has to be better defined. Immunotherapy might improve treatment outcomes of both drug-susceptible and -resistant tuberculosis, and warrants further exploration.

Octreotide treatment of idiopathic pulmonary fibrosis: a proof-of-concept study: Table 1–

“…For the whole population, median FVC was 2.23 L (95% CI 1.22-3.80 L) at study entry and 2.20 L (95% CI 0.99-4.71 L) after 48 weeks. The percentage of decliners seen in our study was lower than the 54% (p50.044) observed in the study by FLAHERTY et al [7], the 55% observed in the placebo group in the etanercept trial (48 weeks) [8] and the 52% reported in a Japanese pirfenidone trial (52 weeks) [9]. At least two measurements of FVC obtained before treatment were available in all patients.…”

The risk of tuberculosis in transplant candidates and recipients: a TBNET consensus statement

“…Close monitoring of liver enzymes is necessary [106] and a pyrazinamide-free regimen is recommended in non-severe hepatic disease. In severe hepatic disease, an isoniazid-and pyrazinamide-free regimen (and even rifampicin-free) should be considered [96,100]. In severe hepatic disease or early after hepatic transplantation, a combination of ethambutol with a later generation fluoroquinolone (e.g moxifloxacin) might be a temporary solution until a more effective regimen can be administered.…”

“…Irrespective of whether a rifamycin is part of an anti-TB drug regimen, the risk of disease recurrence is low when treatment is extended beyond 12 months [99]. Isoniazid-free and pyrazinamide-free regimens similar to those used in immunocompetent individuals [96,100] should be used in case of resistance or intolerance.…”

Rational use of anti-tuberculosis drugs in the EU: better patient care and less drug resistance

“…The new TB drug discovery pipeline appears promising; however, there are only two new classes of drugs, which are currently undergoing final phases of clinical trials and may be widely available in the next 2 yrs [19,21,22]. Recently, concerns have been raised about whether the use of new TB drugs should be prioritised for the treatment of drug-susceptible or drugresistant TB.…”

“…Optimal usage of current TB drugs, expanding access and preventing the development of drug resistance remain top priorities [19].…”