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Chapter 7 : Chemotherapy of Tuberculosis

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Abstract:

Here we review the underlying principles of tuberculosis (TB) chemotherapy, medical management, and current treatment recommendations for drug-susceptible TB.

Citation: Dobbs T, Webb R. 2017. Chemotherapy of Tuberculosis, p 101-117. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0040-2017
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Figure 1

Management of drug-susceptible TB. EMB may be discontinued if isolate is known to be susceptible to INH, RIF, and PZA. Delayed culture conversion should prompt consideration of acquired drug resistance, noncompliance, and malabsorption. Additional duration of treatment may be considered in the following settings: delayed clinical or radiographic improvement, cavitary disease regardless of sputum conversion, extensive disease, active smoking, diabetes, HIV, > 10% below ideal body weight, or other immunocompromising conditions.

Citation: Dobbs T, Webb R. 2017. Chemotherapy of Tuberculosis, p 101-117. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0040-2017
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Figure 2

Management of hepatotoxicity. (Prompt referral to a specialist may be indicated if dysfunction is severe or patient does not improve promptly.) If cholestatic pattern, RIF likely etiology and rifabutin may be appropriate substitute after normalization of LFT’s. If patient has extensive disease, meningitis, HIV coinfection, or requires a prolonged period off first-line agents, prompt initiation of a nonhepatotoxic regimen such as EMB, a fluoroquinolone, cycloserine, and an aminoglycoside should be pursued. Referal to a hepatologist or gastroenterologist may be indicated for delayed improvement or severe symptoms (i.e., intractable nausea and vomiting, elevated INR, lethargy, or coma). Rechallenge with PZA can be considered if hepatitis was not severe. See “Treatment Regimens”.

Citation: Dobbs T, Webb R. 2017. Chemotherapy of Tuberculosis, p 101-117. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0040-2017
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Tables

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Table 1

Drug characteristics

Citation: Dobbs T, Webb R. 2017. Chemotherapy of Tuberculosis, p 101-117. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0040-2017
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Table 2

Dosing of first-line TB drugs

Citation: Dobbs T, Webb R. 2017. Chemotherapy of Tuberculosis, p 101-117. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0040-2017
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Table 3

Weight-based dosing for PZA and EMB

Citation: Dobbs T, Webb R. 2017. Chemotherapy of Tuberculosis, p 101-117. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0040-2017
Generic image for table
Table 4

Alternative treatment regimens in patients intolerant or resistant to INH, RIF, or PZA

Citation: Dobbs T, Webb R. 2017. Chemotherapy of Tuberculosis, p 101-117. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0040-2017
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Table 5

Dosing with renal dysfunction

Citation: Dobbs T, Webb R. 2017. Chemotherapy of Tuberculosis, p 101-117. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0040-2017
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Table 6

Preferred first-line treatment regimens

Citation: Dobbs T, Webb R. 2017. Chemotherapy of Tuberculosis, p 101-117. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0040-2017
Generic image for table
Table 7

Baseline assessment and monitoring schedule for patient on treatment for

Citation: Dobbs T, Webb R. 2017. Chemotherapy of Tuberculosis, p 101-117. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0040-2017
Generic image for table
Table 8

Management of treatment interruptions

Citation: Dobbs T, Webb R. 2017. Chemotherapy of Tuberculosis, p 101-117. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0040-2017

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