What is an overview of Tuberculosis (TB)?

From the Guidelines

Tuberculosis (TB) is a bacterial infection caused by Mycobacterium tuberculosis that primarily affects the lungs but can spread to other parts of the body, and the most recent and highest quality study recommends that treatment of drug-resistant TB should be focused on both curing the individual patient and minimizing the transmission of Mycobacterium tuberculosis to other persons 1.

Overview of Tuberculosis

Tuberculosis (TB) is a major global health concern, particularly in developing countries, and it can be latent or active, with common symptoms including persistent cough, chest pain, coughing up blood, fatigue, weight loss, fever, and night sweats.

• The disease is transmitted through the air when an infected person coughs, sneezes, or speaks.
• Diagnosis typically involves skin tests, blood tests, chest X-rays, and sputum tests.
• Treatment for active TB requires a combination of antibiotics taken for 6-9 months, typically including isoniazid, rifampin, ethambutol, and pyrazinamide for the first two months, followed by isoniazid and rifampin for the remaining period.

Treatment of Drug-Resistant TB

The treatment of drug-resistant TB should include only drugs to which the patient’s M. tuberculosis isolate has documented, or high likelihood of, susceptibility, and drugs known to be ineffective on the basis of in vitro growth-based or molecular DST should not be used 1.

• The use of second-line drugs, which have toxicities that increase harms that must be balanced with their benefits, is recommended.
• Prolonged treatment durations are also recommended for drug-resistant TB.
• Prevention measures include vaccination with BCG (Bacillus Calmette-Guérin) in high-risk areas, early detection, proper treatment completion, and infection control measures.

Recent Guidelines

The most recent guidelines for the treatment of drug-resistant TB recommend that the treatment regimen should be individualized based on the patient's specific needs and circumstances, and that the treatment should be supervised by a healthcare provider with experience in the treatment of TB 1.

• The guidelines also recommend that the treatment regimen should include a combination of antibiotics, and that the patient should be monitored closely for adverse reactions and treatment outcomes.
• The use of bedaquiline, a diarylquinoline, is recommended for the treatment of multidrug-resistant TB, as it has been shown to be effective in improving treatment outcomes 1.

From the FDA Drug Label

Isoniazid is recommended for all forms of tuberculosis in which organisms are susceptible. However, active tuberculosis must be treated with multiple concomitant antituberculosis medications to prevent the emergence of drug resistance. Although there have not been the same kinds of carefully conducted controlled trials of treatment of Extra pulmonary tuberculosis as for pulmonary disease, increasing clinical experience indicates that a 6 to 9 month short-course regimen is effective The basic principles that underlie the treatment of pulmonary tuberculosis also apply to Extra pulmonary forms of the disease

Overview of Tuberculosis:

• Tuberculosis is a disease that requires multiple concomitant antituberculosis medications to prevent the emergence of drug resistance.
• The treatment regimen for tuberculosis depends on the form of the disease, with pulmonary tuberculosis typically requiring a 6 to 9 month short-course regimen.
• Extra pulmonary tuberculosis, such as military tuberculosis, bone/joint tuberculosis, and tuberculous meningitis, may require longer treatment durations, up to 12 months.
• Key considerations for tuberculosis treatment include:
  • Preventing the emergence of drug-resistant organisms
  • Individualizing treatment based on susceptibility studies
  • Using adjunctive therapies, such as surgery and corticosteroids, as needed
  • Ensuring patient compliance with treatment through directly observed therapy (DOT) 2, 2, 2

From the Research

Overview of Tuberculosis

• Tuberculosis (TB) is a primordial infectious disease that mainly affects the lungs, caused by Mycobacterium tuberculosis [ 3 ].
• According to the World Health Organization (WHO), more than one-third of the world population is suffering from TB [ 3 ].
• TB can present as "latent" TB and active TB disease, with different treatments for each [ 4 ].

Treatment of Tuberculosis

• First-line therapy for active TB typically consists of isoniazid, rifampin, pyrazinamide, and ethambutol for the initial two-month phase, followed by isoniazid and rifampin for 4 to 7 months [ 5 ].
• Directly-observed therapy (DOT) remains the standard of care for pulmonary TB, with virtual treatment monitoring using digital technologies becoming more common [ 5 ].
• Treatment for latent TB infection (LTBI) often involves rifamycin-based regimens, which have been successful in preventing progression to TB disease [ 5 ].
• Newer studies are investigating even shorter LTBI treatment durations, with some regimens showing promise [ 5 ].

Drug-Resistant Tuberculosis

• Drug-resistant TB is an increasing concern, with multiple drug-resistant tuberculosis (MDR-TB) infections posing a significant challenge [ 3 ].
• Repurposed drugs, such as moxifloxacin and levofloxacin, and new drugs, like bedaquiline and delamanid, are being used to treat drug-resistant TB [ 4 ].
• Selecting drugs without overlapping adverse drug reaction profiles is a key challenge in treating drug-resistant TB [ 4 ].

Pharmacokinetics and Pharmacodynamics

• The pharmacokinetics of TB drugs, such as rifampin, isoniazid, pyrazinamide, and ethambutol, can vary significantly between patients [ 6 ].
• Factors such as human immunodeficiency virus infection, formulation, and patient demographics can influence drug concentrations [ 6 ].
• Understanding the pharmacokinetics and pharmacodynamics of TB drugs is crucial for optimizing treatment regimens and improving patient outcomes [ 4 ].