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M9460334.TXT
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Document 0334
DOCN M9460334
TI Treatment of tuberculosis and tuberculosis infection in adults and
children. American Thoracic Society and The Centers for Disease Control
and Prevention.
DT 9408
AU Bass JB Jr; Farer LS; Hopewell PC; O'Brien R; Jacobs RF; Ruben F; Snider
DE Jr; Thornton G
SO Am J Respir Crit Care Med. 1994 May;149(5):1359-74. Unique Identifier :
AIDSLINE MED/94228083
AB Treatment of Tuberculosis. 1. A 6-mo regimen consisting of isoniazid,
rifampin, and pyrazinamide given for 2 mo followed by isoniazid and
rifampin for 4 mo is the preferred treatment for patients with fully
susceptible organisms who adhere to treatment. Ethambutol (or
streptomycin in children too young to be monitored for visual acuity)
should be included in the initial regimen until the results of drug
susceptibility studies are available, unless there is little possibility
of drug resistance (i.e., there is less than 4% primary resistance to
isoniazid in the community, and the patient has had no previous
treatment with antituberculosis medications, is not from a country with
a high prevalence of drug resistance, and has no known exposure to a
drug-resistant case). This four-drug, 6-mo regimen is effective even
when the infecting organism is resistant to INH. This recommendation
applies to both HIV-infected and uninfected persons. However, in the
presence of HIV infection it is critically important to assess the
clinical and bacteriologic response. If there is evidence of a slow or
suboptimal response, therapy should be prolonged as judged on a case by
case basis. 2. Alternatively, a 9-mo regimen of isoniazid and rifampin
is acceptable for persons who cannot or should not take pyrazinamide.
Ethambutol (or streptomycin in children too young to be monitored for
visual acuity) should also be included until the results of drug
susceptibility studies are available, unless there is little possibility
of drug resistance (see Section 1 above). If INH resistance is
demonstrated, rifampin and ethambutol should be continued for a minimum
of 12 mo. 3. Consideration should be given to treating all patients with
directly observed therapy (DOT). 4. Multiple-drug-resistant tuberculosis
(i.e., resistance to at least isoniazid and rifampin) presents difficult
treatment problems. Treatment must be individualized and based on
susceptibility studies. In such cases, consultation with an expert in
tuberculosis is recommended. 5. Children should be managed in
essentially the same ways as adults using appropriately adjusted doses
of the drugs. This document addresses specific important differences
between the management of adults and children. 6. Extrapulmonary
tuberculosis should be managed according to the principles and with the
drug regimens outlined for pulmonary tuberculosis, except for children
who have miliary tuberculosis, bone/joint tuberculosis, or tuberculous
meningitis who should receive a minimum of 12 mo of therapy.(ABSTRACT
TRUNCATED AT 400 WORDS)
DE Adolescence Adult Antitubercular Agents/ADMINISTRATION &
DOSAGE/ADVERSE EFFECTS Child Human Tuberculosis/*DRUG
THERAPY/PREVENTION & CONTROL Tuberculosis, Multidrug-Resistant/DRUG
THERAPY GUIDELINE JOURNAL ARTICLE PRACTICE GUIDELINE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).