Treatment of drug-resistant pulmonary tuberculosis in adults
- Neil W Schluger, MD
Neil W Schluger, MD
- Professor of Medicine
- Columbia University College of Physicians and Surgeons
- Scott K Heysell, MD, MPH
Scott K Heysell, MD, MPH
- Associate Professor, Infectious Diseases and International Health
- University of Virginia
- Gerald Friedland, MD
Gerald Friedland, MD
- Professor of Medicine and Epidemiology
- Yale University
Tuberculosis (TB) is a leading cause of morbidity and mortality worldwide. Diagnosis, treatment, and prevention of TB has become more complex because of resistance to commonly used antituberculous drugs. (See "Epidemiology and molecular mechanisms of drug-resistant tuberculosis".)
Management of drug-resistant TB can be difficult and may necessitate use of second-line drugs and/or surgical resection. Management of such patients should be undertaken by individuals with expertise in this area or in very close consultation with such individuals, in the context of a supportive public health infrastructure [1-3]. Good patient outcomes depend upon rapid and accurate diagnosis together with administration of proper therapy with close monitoring to assure adherence to the treatment regimen and patient safety.
Issues related to treatment of drug-resistant TB are reviewed here. Issues related to treatment of drug-susceptible TB are discussed separately, as are issues related to interactions between second-line TB drugs and antiretroviral therapy in HIV-infected individuals. (See "Treatment of drug-susceptible pulmonary tuberculosis in HIV-uninfected adults" and "Treatment of pulmonary tuberculosis in HIV-infected adults", section on 'Interactions with ART and second-line TB drugs'.)
Definitions to describe the different types of drug-resistant tuberculosis include the following:
●The term "drug-resistant tuberculosis" refers to TB caused by an isolate of Mycobacterium tuberculosis that is resistant to one or more antituberculous drugs.
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- CLINICAL PRESENTATION
- EMPIRIC TREATMENT
- TREATMENT OF MONORESISTANT TB
- Isoniazid monoresistance
- Monoresistance to other agents
- TREATMENT OF POLY-RESISTANT TB
- TREATMENT OF MULTIDRUG-RESISTANT TB
- Clinical approach
- - Nonpregnant adults
- General principles
- - Conventional regimen
- - Shortened regimen
- - Children
- - Pregnant women
- - Treatment failure
- TREATMENT OF EXTENSIVELY DRUG-RESISTANT TB
- Clinical approach
- HIV-INFECTED PATIENTS
- ROLE OF SURGERY FOR MDR- OR XDR-TB
- RESOURCES FOR EXPERT GUIDANCE
- SUMMARY AND RECOMMENDATIONS