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Drug-Susceptible Tuberculosis

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2 Key Points ➤ Treatment of tuberculosis is focused on both curing the individual patient and minimizing the transmission of Mycobacterium tuberculosis to other persons. ➤ The objectives of tuberculosis therapy are: • to rapidly reduce the number of actively growing bacilli in the patient, thereby decreasing severity of the disease, preventing death and halting transmission of M. tuberculosis • to eradicate populations of persisting bacilli in order to achieve durable cure (prevent relapse) after completion of therapy • to prevent acquisition of drug resistance during therapy. ➤ Given the public health implications of prompt diagnosis and effective management of tuberculosis, empiric multidrug treatment is initiated in almost all situations in which active tuberculosis is suspected. ➤ Tuberculosis treatment requires multiple drugs be given for several months, and as such it is crucial that the patient be involved in a meaningful way in making decisions concerning treatment supervision and overall care, including decisions around the use of directly observed therapy (DOT), which remains the standard of practice in the majority of tuberculosis programs in the United States and Europe. ➤ The preferred regimen for treating adults with tuberculosis caused by organisms that are not known or suspected to be drug resistant is a regimen consisting of an intensive phase of 2 months of isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB) followed by a continuation phase of 4 months of INH and RIF. ➤ With respect to administration schedule, the preferred frequency is once daily for both the intensive and continuation phases. Nonetheless, on the basis of substantial clinical experience, experts believe that 5-days-a-week drug administration by DOT is an acceptable alternative to 7-days-a-week administration, and either approach may be considered as meeting the definition of "daily" dosing.

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