Tuberculosis Warning: You are not logged in. Your IP address will be publicly visible if you make any edits. If you log in or create an account, your edits will be attributed to your username, along with other benefits.Anti-spam check. Do not fill this in! == Treatment == {{Main|Tuberculosis management}} [[File:Tubi - 1234,0186.jpg|thumb|Tuberculosis phototherapy treatment on 3 March 1934, in [[Kuopio]], [[Finland]]]] Treatment of TB uses antibiotics to kill the bacteria. Effective TB treatment is difficult, due to the unusual structure and chemical composition of the mycobacterial [[Cord factor|cell wall]], which hinders the entry of drugs and makes many antibiotics ineffective.<ref>{{cite journal | vauthors = Brennan PJ, Nikaido H | title = The envelope of mycobacteria | journal = Annual Review of Biochemistry | volume = 64 | pages = 29–63 | year = 1995 | pmid = 7574484 | doi = 10.1146/annurev.bi.64.070195.000333 }}</ref> Active TB is best treated with combinations of several antibiotics to reduce the risk of the bacteria developing [[antibiotic resistance]].<ref name=Lancet11/> The routine use of [[rifabutin]] instead of [[rifampicin]] in HIV-positive people with tuberculosis is of unclear benefit {{as of|2007|lc=yes}}.<ref>{{cite journal | vauthors = Davies G, Cerri S, Richeldi L | title = Rifabutin for treating pulmonary tuberculosis | journal = The Cochrane Database of Systematic Reviews | issue = 4 | pages = CD005159 | date = October 2007 | volume = 2007 | pmid = 17943842 | pmc = 6532710 | doi = 10.1002/14651858.CD005159.pub2 }}</ref> Acetylsalicylic acid (aspirin) at a dose of 100 mg per day has been shown to improve clinical signs and symptoms, reduce cavitary lesions, lower inflammatory markers, and increase the rate of sputum-negative conversion in patients with pulmonary tuberculosis.<ref>{{cite journal | vauthors = Di Bella S, Luzzati R, Principe L, Zerbato V, Meroni E, Giuffrè M, Crocè LS, Merlo M, Perotto M, Dolso E, Maurel C, Lovecchio A, Dal Bo E, Lagatolla C, Marini B, Ippodrino R, Sanson G | display-authors = 6 | title = Aspirin and Infection: A Narrative Review | journal = Biomedicines | volume = 10 | issue = 2 | pages = 263 | date = January 2022 | pmid = 35203473 | pmc = 8868581 | doi = 10.3390/biomedicines10020263 | doi-access = free }}</ref> === Latent TB === Latent TB is treated with either [[isoniazid]] or [[rifampin]] alone, or a combination of isoniazid with either rifampicin or rifapentine.<ref name="WHOlatent2018">{{cite book | publisher=[[World Health Organization]] (WHO) | title=Latent tuberculosis infection | year=2018 | page=23 | isbn=978-92-4-155023-9 | url=http://apps.who.int/iris/bitstream/handle/10665/260233/9789241550239-eng.pdf;jsessionid=E08401544A59BE3F84C645C9A9A7B0E5?sequence=1 | access-date=25 July 2018 | archive-date=2 June 2021 | archive-url=https://web.archive.org/web/20210602215123/http://apps.who.int/iris/bitstream/handle/10665/260233/9789241550239-eng.pdf;jsessionid=E08401544A59BE3F84C645C9A9A7B0E5?sequence=1 | url-status=live }}</ref><ref>{{cite journal | vauthors = Borisov AS, Bamrah Morris S, Njie GJ, Winston CA, Burton D, Goldberg S, Yelk Woodruff R, Allen L, LoBue P, Vernon A | display-authors = 6 | title = Update of Recommendations for Use of Once-Weekly Isoniazid-Rifapentine Regimen to Treat Latent Mycobacterium tuberculosis Infection | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 67 | issue = 25 | pages = 723–726 | date = June 2018 | pmid = 29953429 | pmc = 6023184 | doi = 10.15585/mmwr.mm6725a5 }}</ref><ref name=Ste2020>{{cite journal | vauthors = Sterling TR, Njie G, Zenner D, Cohn DL, Reves R, Ahmed A, Menzies D, Horsburgh CR, Crane CM, Burgos M, LoBue P, Winston CA, Belknap R | display-authors = 6 | title = Guidelines for the Treatment of Latent Tuberculosis Infection: Recommendations from the National Tuberculosis Controllers Association and CDC, 2020 | language = en-us | journal = MMWR. Recommendations and Reports | volume = 69 | issue = 1 | pages = 1–11 | date = February 2020 | pmid = 32053584 | pmc = 7041302 | doi = 10.15585/mmwr.rr6901a1 }}</ref> The treatment takes three to nine months depending on the medications used.<ref name=CDCcourse/><ref name="WHOlatent2018"/><ref>{{cite journal | vauthors = Njie GJ, Morris SB, Woodruff RY, Moro RN, Vernon AA, Borisov AS | title = Isoniazid-Rifapentine for Latent Tuberculosis Infection: A Systematic Review and Meta-analysis | journal = American Journal of Preventive Medicine | volume = 55 | issue = 2 | pages = 244–252 | date = August 2018 | pmid = 29910114 | pmc = 6097523 | doi = 10.1016/j.amepre.2018.04.030 }}</ref><ref name=Ste2020/> People with latent infections are treated to prevent them from progressing to active TB disease later in life.<ref name=Latent2011>{{cite journal | vauthors = Menzies D, Al Jahdali H, Al Otaibi B | title = Recent developments in treatment of latent tuberculosis infection | journal = The Indian Journal of Medical Research | volume = 133 | issue = 3 | pages = 257–66 | date = March 2011 | pmid = 21441678 | pmc = 3103149 }}</ref> Education or counselling may improve the latent tuberculosis treatment completion rates.<ref>{{cite journal | vauthors = M'imunya JM, Kredo T, Volmink J | title = Patient education and counselling for promoting adherence to treatment for tuberculosis | journal = The Cochrane Database of Systematic Reviews | issue = 5 | pages = CD006591 | date = May 2012 | volume = 2012 | pmid = 22592714 | pmc = 6532681 | doi = 10.1002/14651858.CD006591.pub2 | collaboration = Cochrane Infectious Diseases Group }}</ref> === New onset === The recommended treatment of new-onset pulmonary tuberculosis, {{as of|2010|lc=yes}}, is six months of a combination of antibiotics containing rifampicin, isoniazid, [[pyrazinamide]], and [[ethambutol]] for the first two months, and only rifampicin and isoniazid for the last four months.<ref name=Lancet11/> Where resistance to isoniazid is high, ethambutol may be added for the last four months as an alternative.<ref name="Lancet11" /> Treatment with anti-TB drugs for at least 6 months results in higher success rates when compared with treatment less than 6 months, even though the difference is small. Shorter treatment regimen may be recommended for those with compliance issues.<ref name="Gelband_1999">{{cite journal | vauthors = Gelband H | title = Regimens of less than six months for treating tuberculosis | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD001362 | date = 25 October 1999 | volume = 1999 | pmid = 10796641 | pmc = 6532732 | doi = 10.1002/14651858.CD001362 | collaboration = Cochrane Infectious Diseases Group }}</ref> There is also no evidence to support shorter anti-tuberculosis treatment regimens when compared to a 6-month treatment regimen.<ref>{{cite journal | vauthors = Grace AG, Mittal A, Jain S, Tripathy JP, Satyanarayana S, Tharyan P, Kirubakaran R | title = Shortened treatment regimens versus the standard regimen for drug-sensitive pulmonary tuberculosis | journal = The Cochrane Database of Systematic Reviews | volume = 12 | pages = CD012918 | date = December 2019 | issue = 12 | pmid = 31828771 | pmc = 6953336 | doi = 10.1002/14651858.CD012918.pub2 | collaboration = Cochrane Infectious Diseases Group }}</ref> However recently, results from an international, randomized, controlled clinical trial indicate that a four-month daily treatment regimen containing high-dose, or "optimized", rifapentine with moxifloxacin (2PHZM/2PHM) is as safe and effective as the existing standard six-month daily regimen at curing drug-susceptible tuberculosis (TB) disease.<ref>{{cite web |title=Landmark TB Trial Identifies Shorter-Course Treatment Regimen |url=https://www.cdc.gov/nchhstp/newsroom/2020/landmark-tb-trial-media-statement.html |website=CDC |date=20 October 2020 |publisher=NCHHSTP Media Team Centers for Disease Control and Prevention |access-date=27 November 2021 |archive-date=27 November 2021 |archive-url=https://web.archive.org/web/20211127171700/https://www.cdc.gov/nchhstp/newsroom/2020/landmark-tb-trial-media-statement.html |url-status=live }}</ref> === Recurrent disease === If tuberculosis recurs, testing to determine which antibiotics it is sensitive to is important before determining treatment.<ref name="Lancet11" /> If [[Multidrug-resistant TB|multiple drug-resistant TB]] (MDR-TB) is detected, treatment with at least four effective antibiotics for 18 to 24 months is recommended.<ref name="Lancet11" /> === Medication administration === [[Directly observed therapy]], i.e., having a health care provider watch the person take their medications, is recommended by the World Health Organization (WHO) in an effort to reduce the number of people not appropriately taking antibiotics.<ref>{{cite book |vauthors = Mainous III AB |title=Management of Antimicrobials in Infectious Diseases: Impact of Antibiotic Resistance |publisher=Humana Press |location=Totowa, NJ |year=2010 |page=69 |isbn=978-1-60327-238-4 |url=https://books.google.com/books?id=hwVFAPLYznsC&pg=PA69 |url-status=live |archive-url=https://web.archive.org/web/20150906215558/https://books.google.com/books?id=hwVFAPLYznsC&pg=PA69 |archive-date=6 September 2015 }}</ref> The evidence to support this practice over people simply taking their medications independently is of poor quality.<ref name=Karumbi2015 /> There is no strong evidence indicating that directly observed therapy improves the number of people who were cured or the number of people who complete their medicine.<ref name=Karumbi2015>{{cite journal | vauthors = Karumbi J, Garner P | title = Directly observed therapy for treating tuberculosis | journal = The Cochrane Database of Systematic Reviews | issue = 5 | page= CD003343 | date = May 2015 | volume = 2015 | pmid = 26022367 | pmc = 4460720 | doi = 10.1002/14651858.CD003343.pub4 }}</ref> Moderate quality evidence suggests that there is also no difference if people are observed at home versus at a clinic, or by a family member versus a health care worker.<ref name=Karumbi2015 /> Methods to remind people of the importance of treatment and appointments may result in a small but important improvement.<ref>{{cite journal | vauthors = Liu Q, Abba K, Alejandria MM, Sinclair D, Balanag VM, Lansang MA | title = Reminder systems to improve patient adherence to tuberculosis clinic appointments for diagnosis and treatment | journal = The Cochrane Database of Systematic Reviews | issue = 11 | pages = CD006594 | date = November 2014 | volume = 2014 | pmid = 25403701 | pmc = 4448217 | doi = 10.1002/14651858.CD006594.pub3 | collaboration = Cochrane Infectious Diseases Group }}</ref> There is also not enough evidence to support intermittent rifampicin-containing therapy given two to three times a week has equal effectiveness as daily dose regimen on improving cure rates and reducing relapsing rates.<ref>{{cite journal | vauthors = Mwandumba HC, Squire SB | title = Fully intermittent dosing with drugs for treating tuberculosis in adults | journal = The Cochrane Database of Systematic Reviews | issue = 4 | pages = CD000970 | date = 23 October 2001 | pmid = 11687088 | pmc = 6532565 | doi = 10.1002/14651858.CD000970 | collaboration = Cochrane Infectious Diseases Group }}</ref> There is also not enough evidence on effectiveness of giving intermittent twice or thrice weekly short course regimen compared to daily dosing regimen in treating children with tuberculosis.<ref>{{cite journal | vauthors = Bose A, Kalita S, Rose W, Tharyan P | title = Intermittent versus daily therapy for treating tuberculosis in children | journal = The Cochrane Database of Systematic Reviews | issue = 1 | pages = CD007953 | date = January 2014 | volume = 2014 | pmid = 24470141 | pmc = 6532685 | doi = 10.1002/14651858.CD007953.pub2 | collaboration = Cochrane Infectious Diseases Group }}</ref> === Medication resistance === Primary resistance occurs when a person becomes infected with a resistant strain of TB. A person with fully susceptible [[Mycobacterium tuberculosis|MTB]] may develop secondary (acquired) resistance during therapy because of inadequate treatment, not taking the prescribed regimen appropriately (lack of compliance), or using low-quality medication.<ref name=OBrien>{{cite journal | vauthors = O'Brien RJ | title = Drug-resistant tuberculosis: etiology, management and prevention | journal = Seminars in Respiratory Infections | volume = 9 | issue = 2 | pages = 104–12 | date = June 1994 | pmid = 7973169 }}</ref> Drug-resistant TB is a serious public health issue in many developing countries, as its treatment is longer and requires more expensive drugs. MDR-TB is defined as resistance to the two most effective first-line TB drugs: rifampicin and isoniazid. Extensively drug-resistant TB is also resistant to three or more of the six classes of second-line drugs.<ref name="MMWR2006">{{cite journal | author = Centers for Disease Control and Prevention (CDC) | title = Emergence of Mycobacterium tuberculosis with extensive resistance to second-line drugs--worldwide, 2000-2004 | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 55 | issue = 11 | pages = 301–5 | date = March 2006 | pmid = 16557213 | url = https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5511a2.htm | url-status = live | archive-url = https://web.archive.org/web/20170522030229/https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5511a2.htm | archive-date = 22 May 2017 }}</ref> Totally drug-resistant TB is resistant to all currently used drugs.<ref name="TR2012">{{Cite magazine|title=Totally Resistant TB: Earliest Cases in Italy|magazine=Wired|url=https://www.wired.com/wiredscience/2012/01/tdr-first-Italy/| vauthors = McKenna M |date=12 January 2012|access-date=12 January 2012|url-status=live|archive-url=https://web.archive.org/web/20120114214156/http://www.wired.com/wiredscience/2012/01/tdr-first-Italy/|archive-date=14 January 2012}}</ref> It was first observed in 2003 in Italy,<ref>{{cite journal | vauthors = Migliori GB, De Iaco G, Besozzi G, Centis R, Cirillo DM | title = First tuberculosis cases in Italy resistant to all tested drugs | journal = Euro Surveillance | volume = 12 | issue = 5 | pages = E070517.1 | date = May 2007 | pmid = 17868596 | doi = 10.2807/esw.12.20.03194-en | doi-access = free }}</ref> but not widely reported until 2012,<ref name="TR2012" /><ref>{{cite web|title=Totally Drug-Resistant TB: a WHO consultation on the diagnostic definition and treatment options|url=https://www.who.int/tb/challenges/xdr/Report_Meeting_totallydrugresistantTB_032012.pdf?ua=1|publisher=World Health Organization (WHO)|access-date=25 March 2016|url-status=live|archive-url=https://web.archive.org/web/20161021151601/http://www.who.int/tb/challenges/xdr/Report_Meeting_totallydrugresistantTB_032012.pdf?ua=1|archive-date=21 October 2016}}</ref> and has also been found in Iran and India.<ref name="EIU 2014">{{cite news | title = Ancient enemy, modern imperative – A time for greater action against tuberculosis | newspaper = The Economist |url=http://www.economistinsights.com/sites/default/files/Ancient%20enemy%20modern%20imperative.pdf |publisher=[[Economist Intelligence Unit]]|access-date=22 January 2022|date=30 June 2014| vauthors = Kielstra P | veditors = Tabary Z |url-status=dead|archive-url=https://web.archive.org/web/20140810101716/http://www.economistinsights.com/sites/default/files/Ancient%20enemy%20modern%20imperative.pdf |archive-date=10 August 2014}}</ref> There is some efficacy for [[linezolid]] to treat those with XDR-TB but side effects and discontinuation of medications were common.<ref>{{cite journal | vauthors = Singh B, Cocker D, Ryan H, Sloan DJ | title = Linezolid for drug-resistant pulmonary tuberculosis | journal = The Cochrane Database of Systematic Reviews | volume = 3 | pages = CD012836 | date = March 2019 | issue = 3 | pmid = 30893466 | pmc = 6426281 | doi = 10.1002/14651858.CD012836.pub2 | collaboration = Cochrane Infectious Diseases Group }}</ref><ref>{{cite journal | vauthors = Velayati AA, Masjedi MR, Farnia P, Tabarsi P, Ghanavi J, ZiaZarifi AH, Hoffner SE | title = Emergence of new forms of totally drug-resistant tuberculosis bacilli: super extensively drug-resistant tuberculosis or totally drug-resistant strains in Iran | journal = Chest | volume = 136 | issue = 2 | pages = 420–425 | date = August 2009 | pmid = 19349380 | doi = 10.1378/chest.08-2427 }}</ref> [[Bedaquiline]] is tentatively supported for use in multiple drug-resistant TB.<ref>{{cite web|title=Provisional CDC Guidelines for the Use and Safety Monitoring of Bedaquiline Fumarate (Sirturo) for the Treatment of Multidrug-Resistant Tuberculosis|url=https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6209a1.htm?s_cid=rr6209a1_x|url-status=live|archive-url=https://web.archive.org/web/20140104204359/http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6209a1.htm?s_cid=rr6209a1_x|archive-date=4 January 2014}}</ref> XDR-TB is a term sometimes used to define ''extensively resistant'' TB, and constitutes one in ten cases of MDR-TB. Cases of XDR TB have been identified in more than 90% of countries.<ref name="EIU 2014"/> For those with known rifampicin or MDR-TB, molecular tests such as the Genotype MTBDRsl Assay (performed on culture isolates or smear positive specimens) may be useful to detect second-line anti-tubercular drug resistance.<ref>{{cite journal | vauthors = Theron G, Peter J, Richardson M, Warren R, Dheda K, Steingart KR | title = ® MTBDRsl assay for resistance to second-line anti-tuberculosis drugs | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | pages = CD010705 | date = September 2016 | issue = 9 | pmid = 27605387 | pmc = 5034505 | doi = 10.1002/14651858.CD010705.pub3 | collaboration = Cochrane Infectious Diseases Group }}</ref><ref>{{cite web |url=https://www.who.int/tb/WHOPolicyStatementSLLPA.pdf |title=The use of molecular line probe assays for the detection of resistance to second-line anti-tuberculosis drugs |website=World Health Organization |access-date=18 June 2021 |archive-date=22 September 2021 |archive-url=https://web.archive.org/web/20210922003541/https://www.who.int/tb/WHOPolicyStatementSLLPA.pdf |url-status=live }}</ref> Summary: Please note that all contributions to Christianpedia may be edited, altered, or removed by other contributors. 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