The treatment of all forms of tuberculosis (TB) is based on two principles: 1) the combination of drugs (at least four) to avoid the selection of anti-TB drug resistances; and 2) the need for prolonged treatment in order to ensure that all bacteria in their different phases of metabolic growth are effectively killed. The selection of drugs to be included in the combination is based on their bactericidal and sterilising capacity, and their ability to prevent drug resistance. Following extensive research in the field in the second part of the last century, the optimal regimen of initial treatment of all forms of drug-sensitive TB, both pulmonary and extrapulmonary, is 2 months of isoniazid (H), rifampicin (R), pyrazinamide (Z) and ethambutol (E), followed by 4 months of treatment with H and R (2HRZE/4HR). The impossibility of using R, the most powerful of all anti-TB drugs, substantially complicates the treatment of TB. In this chapter, we discuss the fundamental basis of anti-TB therapy, demonstrating that with proper clinical and operational management, patients with TB have a high probability of being cured, even though this probability is reduced with increasing levels of Mycobacterium tuberculosis drug resistance. © ERS 2012.
Treatment of TB
Matteelli A.;
2012-01-01
Abstract
The treatment of all forms of tuberculosis (TB) is based on two principles: 1) the combination of drugs (at least four) to avoid the selection of anti-TB drug resistances; and 2) the need for prolonged treatment in order to ensure that all bacteria in their different phases of metabolic growth are effectively killed. The selection of drugs to be included in the combination is based on their bactericidal and sterilising capacity, and their ability to prevent drug resistance. Following extensive research in the field in the second part of the last century, the optimal regimen of initial treatment of all forms of drug-sensitive TB, both pulmonary and extrapulmonary, is 2 months of isoniazid (H), rifampicin (R), pyrazinamide (Z) and ethambutol (E), followed by 4 months of treatment with H and R (2HRZE/4HR). The impossibility of using R, the most powerful of all anti-TB drugs, substantially complicates the treatment of TB. In this chapter, we discuss the fundamental basis of anti-TB therapy, demonstrating that with proper clinical and operational management, patients with TB have a high probability of being cured, even though this probability is reduced with increasing levels of Mycobacterium tuberculosis drug resistance. © ERS 2012.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
