Tuberculosis (TB) is nearly always curable if patients are treated with effective, uninterrupted antituberculous therapy. Adherence to treatment is critical for cure of individual patients, controlling spread of infection and minimizing the development of drug resistance [1,2].
Issues related to treatment adherence will be reviewed here. The clinical approach to treatment of TB is discussed in detail separately. (See "Treatment of pulmonary tuberculosis in HIV-negative patients" and "Treatment of pulmonary tuberculosis in the HIV-infected patient".)
CHALLENGES OF ADHERENCE
Incomplete adherence to treatment has been identified as the most serious problem in tuberculosis control , and a major obstacle to the elimination of the disease . In one retrospective study including 184 patients with TB in New York City (nearly half of whom were nonadherent), the nonadherent patients took longer to convert to negative culture results (254 versus 64 days), were more likely to acquire drug resistance (relative risk 5.6), and required longer treatment regimens (560 versus 324 days) .
Treatment adherence can be particularly challenging in the setting of tuberculosis; the duration of treatment is long (usually six months or longer), combination therapy is required, and side effects may be unpleasant.
Factors affecting adherence — Successful treatment among patients with TB may be influenced by several factors: