Updates in the Treatment of Active and Latent Tuberculosis

Abstract

First-line therapy for active tuberculosis (TB) has remained unchanged for nearly 40 years. Isoniazid, rifampin, pyrazinamide, and ethambutol for the initial two-month phase followed by isoniazid and rifampin for 4 to 7 months is standard treatment for people at low risk for drug-resistant disease. Directly-observed therapy (DOT) remains the standard of care for pulmonary TB. Virtual treatment monitoring using digital technologies is becoming more common as a way to provide a more patient-centered approach to care. Attempts to shorten treatment duration have been unsuccessful based on recent clinical trials evaluating the role of fluoroquinolones. Treatment-shortening trials using higher doses of rifamycins are currently underway. Recently approved medications for TB treatment are recommended only for drug-resistant disease, but novel agents in varying stages of development are being evaluated. Rifamycin-based regimens for latent TB infection (LTBI) have been successful in preventing progression to TB disease. Once-weekly isoniazid and rifapentine for 12 weeks by DOT was shown to be safe and effective compared with 9 months of isoniazid. The same regimen was shown to have acceptable treatment completion when given self-administered. Newer studies are investigating even shorter LTBI treatment with durations of less than 2 months. Treatment of LTBI in people likely infected with multidrug resistant TB is very limited, but one observational study found that fluoroquinolones appear to be effective. The first randomized trials for treating LTBI in contacts to MDR-TB are currently enrolling.

Timing of treatment interruption among latently infected tuberculosis cases treated with a nine-month course of daily isoniazid: findings from a time to event analysis

“…Isoniazid (INH) was the first anti-tuberculosis drug recommended for LTBI treatment, a decision supported by findings from several randomized clinical trials conducted in the 1960s [10, 11]. Although a prescribed nine-month INH regimen is preferred and considered more efficacious, a six-month INH regimen can be alternatively prescribed to improve patient adherence [12].…”

Review Article: Virulence Factors of Mycobacterium Tuberculosis

“…Likewise bacterial Actinomycetaceae or Mycobacteriaceae families of the order Actinomycetales consist of the genera Actinomyces, Nocardia, or Rhodococcus, respectively. While some of the transmissible Actinomycetaceae are frequently misidentified as fungi as well as the illnesses that they trigger frequently coincide with those linked to the true fungi according to the umbrella term of mycoses, mycobacterial ailments are classified as microbes as well as remain regarded as between bacterial infections [38] . In spite of other well-known terminological contradictions as well as dangers like mycotic aneurysm,as well as mycosis fungoides , this may be challenging to dispel these myth, especially in light of this ingrained nosological designation as actinomycosis, that from because of the terminating '-mycosis' -its etymology is frequently misunderstanding -is not likely to get evacuated to its prevalent collaboration in actual mycoses.…”

Predicting the artificial immunity induced by RUTI® vaccine against tuberculosis using universal immune system simulator (UISS)

“…Rifamycin-based regimens for LTBI have been successful in preventing progression to TB disease [23]. However, treatment of LTBI needs a long period of chemotherapy, approximately 9 months, leading to an extremely difficulty in terms of management and treatment-compliance therapy [24].…”