Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska
Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska
Duration of Treatment Use the treatment algorithm in Figure 1: Treatment Algorithm for Drug-susceptible Tuberculosis in Adults to determine the duration of treatment. The four recommended regimens for treating patients with TB caused by drug-susceptible organisms have a duration of six to nine months. Each regimen has an initial phase of two months, followed by a continuation phase of either four or seven months. Figure 1 gives directions for treating patients with pulmonary and extrapulmonary TB. The standard duration of treatment for pulmonary TB should be six months unless both cavitation is present and the patient is still culture positive after two months, in which case nine months is recommended. Note that there are three exceptions to the standard six-month duration of treatment. 1. For tuberculous meningitis, the optimal length of therapy has not been established, although some experts recommend 9 to 12 months. 5 2. Treatment for bone or joint TB may need to extend to nine months. 6 3. In HIV-negative, culture-negative patients, treatment for four months may be adequate if there is clinical or radiographic improvement and no other etiology identified. 7 However, HIV-infected patients with culture-negative pulmonary TB should be treated for a minimum of six months. 8 A L A S K A T U B E R C U L O S I S P R O G R A M M A N U A L Treatment of Tuber culosis Disease 6.11 Revised November 2012
Figure 1:TREATMENT ALGORITHM FOR DRUG-SUSCEPTIBLE TUBERCULOSIS IN ADULTS High suspicion of active TB I/R/P/E Cavitation on initial CXR (AFB smear + or -) Chest x-ray No cavitation on initial CXR (AFB smear + or -) For selected patients: AFB smear negative HIV negative I/RPT 2-mo culture negative Culture 2-mo culture positive 2-mo culture negative Culture 2-mo culture positive 0 mo. 1 mo. 2 mo. 3 mo. 4 mo. 5 mo. 6 mo. 7 mo. 8 mo. 9 mo. Culture sputa after 8 wks of treatment. A L A S K A T U B E R C U L O S I S P R O G R A M M A N U A L Treatment of Tuber culosis Disease 6.12 Revised November 2012 I/R I/R I/R I/RPT I/RPT 1, 2 Legend I=Isoniazid R=Rifampin P=Pyrazinamide E=Ethambutol RPT=Rifapentine 1 Do not use weekly rifapentine for patients who have HIV infection or extra-pulmonary TB 2 Extend treatment to 9 mo. if sputum is culture-positive at 8 weeks (Adapted from Blumberg, HM, Leonard MK, Jasner RM. Update on the treatment of tuberculosis and latent tuberculosis infection. JAMA 2005;293:2776-84.)
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Duration <strong>of</strong> Treatment<br />
Use the treatment algorithm in Figure 1: Treatment Algorithm for Drug-susceptible<br />
<strong>Tuberculosis</strong> in Adults to determine the duration <strong>of</strong> treatment. The four recommended<br />
regimens for treating patients with TB caused by drug-susceptible organisms have a<br />
duration <strong>of</strong> six to nine months. Each regimen has an initial phase <strong>of</strong> two months,<br />
followed by a continuation phase <strong>of</strong> either four or seven months.<br />
Figure 1 gives directions for treating patients with pulmonary and extrapulmonary TB.<br />
The standard duration <strong>of</strong> treatment for pulmonary TB should be six months unless both<br />
cavitation is present and the patient is still culture positive after two months, in which<br />
case nine months is recommended. Note that there are three exceptions to the standard<br />
six-month duration <strong>of</strong> treatment.<br />
1. For tuberculous meningitis, the optimal length <strong>of</strong> therapy has not been established,<br />
although some experts recommend 9 to 12 months. 5<br />
2. Treatment for bone or joint TB may need to extend to nine months. 6<br />
3. In HIV-negative, culture-negative patients, treatment for four months may be<br />
adequate if there is clinical or radiographic improvement and no other etiology<br />
identified. 7 However, HIV-infected patients with culture-negative pulmonary TB<br />
should be treated for a minimum <strong>of</strong> six months. 8<br />
A L A S K A T U B E R C U L O S I S P R O G R A M M A N U A L Treatment <strong>of</strong> Tuber culosis Disease 6.11<br />
Revised November 2012
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