Tuberculosis (TB) has emerged as a global public health epidemic. Despite decreasing numbers of cases in the United States since 1992, TB remains a serious public health problem among certain patient populations and is highly prevalent in many urban areas. The responsibility for prescribing an appropriate drug regimen and ensuring that treatment is completed is assigned to the public health program or the clinician not to the patient. The initial prescribed regimen for the treatment of TB usually consists of 4 drugs: isoniazid, rifampin, pyrazinamide, and ethambutol. The minimum length for the treatment of drug-susceptible TB with a rifampin-based regimen is 6 to 9 months. Providing medications directly to the patient and watching him/her swallow the anti-TB drugs, which is termed directly observed therapy, is recommended for all patients diagnosed with TB and can help ensure higher completion rates, prevent the emergence of drug resistant TB, and enhance TB control. There has been renewed interest in the treatment of those with latent TB infection as a TB-control strategy in the United States for eliminating the large reservoir of individuals at risk for progression to TB. The 2 broad categories of persons who should be tested for latent TB infection are those who are likely to have been recently infected (such as contacts to infectious TB cases) and persons who are at increased risk of progression to TB disease following infection with Mycobacterium tuberculosis (eg, human immunodeficiency virus infection and selected medical conditions; recent immigrants to the United States from high TB-burden countries). The preferred regimen for the treatment of latent TB infection is 9 months of isoniazid. There is now renewed interest in and great need for the development of new drugs to treat TB and latent TB infection.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Error bars indicate range. DOT indicates directly observed therapy; TB, tuberculosis. Source: Chauk et al.9
Patients in whom tuberculosis (TB) is proved or strongly suspected should have treatment initiated with isoniazid, rifampin, pyrazinamide, and ethambutol for the initial 2 months of treatment. A repeat acid-fast bacilli (AFB) smear and culture should be performed when the initial 2 months of drug treatment has been completed. If cavitation was present on the initial chest radiograph and the TB culture was positive after 2 months of therapy, the continuation phase should be extended to 7 months (total treatment: 9 months). If cavitation was present on the initial chest radiograph but the TB culture was negative at 2 months, the total length of therapy should be 6 months (2 months of initial therapy and 4 months in the continuation phase). If a patient was infected with human immunodeficiency virus (HIV) and his/her CD4 cell count was lower than 100/μL, the continuation phase should consist of isoniazid and rifampin daily or 3 times weekly. In patients without HIV, without cavitation on chest radiograph, and negative AFB smears at completion of initial 2-month treatment, the continuation phase may consist of either (1) once-weekly isoniazid and rifapentine or (2) isoniazid and rifampin daily or twice weekly (total treatment: 6 months). In patients who took isoniazid and rifapentine and whose 2-month cultures were positive, treatment should be extended 3 months (total treatment: 9 months). Asterisk indicates ethambutol may be discontinued when results of drug susceptibility testing indicate no drug resistance. Dagger indicates pyrazinamide may be discontinued after it has been taken for 2 months. Double dagger indicates rifapentine should not be used in patients who have HIV and TB or in patients with extrapulmonary TB. Section symbol indicates therapy should be extended to 9 months if the 2-month culture was positive. Source: Blumberg et al.5
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Instructions
Thank you for submitting a comment on this article. It will be reviewed by JAMA editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest* Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 77
Customize your page view by dragging & repositioning the boxes below.
Author in the Room
JAMA: 2005-06-08, Vol. 293, No. 22, Author in the Room Audio Interview (1:00:34)
More Listings atJAMACareerCenter.com >
and access these and other features:
Register Now
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Need assistance?
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.