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January 09, 2023
Short-course rifapentine-based regimen for the treatment of drug-susceptible pulmonary tuberculosis The Centers for Disease Control and Prevention now recommends a four-month, four-drug regimen for certain patient populations with newly diagnosed, drug-susceptible tuberculosis. The regimen consisting of an intensive phase with once daily rifapentine, isoniazid, pyrazinamide, and moxifloxacin for 8 weeks, followed by once daily RPT, INH, MOX for 9 weeks was found to be non-inferior to traditional 4-drug regimen. The shorter course is intended to facilitate rapid cure and improve patient compliance and quality of life.
Upon completion of the chapter, the reader will be able to:
Assess risk factors for developing an active tuberculosis (TB) infection.
Design appropriate antimicrobial regimens for the treatment of latent TB infection.
Design an appropriate therapeutic plan for a patient with active TB disease.
Distinguish among the diagnostic tests used for patients potentially infected with TB.
Determine appropriate monitoring parameters to evaluate the efficacy and safety of an active drug regimen for active TB.
Describe potential adverse reactions associated with TB medications.
Select patients for whom therapeutic drug monitoring (TDM) may be valuable and identify the necessary laboratory monitoring parameters for patients on anti-TB medications.
Tuberculosis (TB) is one of the leading causes of death from infectious origin worldwide. In 2018, there were about 10 million new cases and an estimated 1.5 million deaths from TB reported.1 Most deaths are preventable if appropriate access to health care for both diagnosis and treatment is available.
EPIDEMIOLOGY AND ETIOLOGY
Roughly one-fourth of the world’s population is infected with tuberculosis; TB and drug resistance is increasing in many areas.1 The majority of cases worldwide are found in South-East Asia (44%) and Africa (24%). In the United States, about 13 million people have latent TB infection (LTBI), evidenced by a positive skin test (purified protein derivative [PPD]) with no concurrent signs or symptoms of disease. PPD is an antigen derived from Mycobacterium tuberculosis used to determine the presence of an immune response in patients with previous exposure.
In 2019, 8920 new TB cases were reported in the United States; a 1.1% decline from 2018.2 The most recent data from the Centers for Disease Control and Prevention (CDC) indicate that TB deaths in the United States have decreased from 2016 by 2.5% in 2017.3 (For details, visit the CDC website at www.cdc.gov/nchstp/tb.) TB is most prevalent in large urban areas and is exacerbated by crowded living conditions.2 Those in close physical contact with patients that have active pulmonary TB are most likely to become infected.2,3 TB cases in California, New York, Florida, and Texas accounted for over 40% of all cases in ...