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.
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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
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