From the Guidelines
Tuberculosis (TB) remains a significant and growing global health problem, with an estimated 10.6 million new cases and 1.6 million deaths in 2021, as reported by the World Health Organization (WHO) in 2022 1. The disease is a major cause of morbidity and mortality worldwide, particularly in developing countries with inadequate healthcare infrastructure, and its impact is further complicated by the emergence of drug-resistant strains, including multidrug-resistant (MDR) and rifampicin-resistant (RR) TB. Key factors contributing to the persistence of TB include:
- Inadequate healthcare infrastructure in high-burden regions
- The HIV epidemic, which increases susceptibility to TB
- Inconsistent treatment adherence, leading to drug resistance
- Socioeconomic factors like poverty and overcrowding, which facilitate transmission Recent advances in treatment have improved outcomes for patients with drug-susceptible and drug-resistant TB, but challenges remain, including the need for longer treatment regimens and the potential for adverse events. According to the most recent guidelines from the WHO, updated in 2022, the use of a 6-month treatment regimen composed of bedaquiline, pretomanid, linezolid, and moxifloxacin (BPaLM) is recommended for patients with MDR/RR-TB, offering a shorter and potentially more effective treatment option 1.
From the FDA Drug Label
Isoniazid is recommended for all forms of tuberculosis in which organisms are susceptible. Candidates for preventive therapy who have HIV infection should have a minimum of 12 months of therapy. Candidates for preventive therapy who have fibrotic pulmonary lesions consistent with healed tuberculosis or who have pulmonary silicosis should have 12 months of isoniazid or 4 months of isoniazid and rifampin, concomitantly
The FDA drug label indicates that tuberculosis is a significant concern that requires preventive therapy for certain groups, including those with HIV infection, close contacts of persons with newly diagnosed infectious tuberculosis, and persons with abnormal chest radiographs.
- High-risk groups include foreign-born persons from high-prevalence countries, medically underserved low-income populations, and residents of facilities for long-term care.
- Preventive therapy is recommended for these groups to prevent the emergence of drug resistance and to reduce the risk of tuberculosis. 2
From the Research
Current Status of TB
- TB remains a significant global health problem, with an estimated 10 million incident cases and 1.5 million TB-related deaths in 2018 3.
- The disease is the leading cause of death from a single infectious disease agent, including among persons living with HIV infection 3.
- The World Health Organization (WHO) has set ambitious targets to reduce TB incidence and deaths, but more intensive efforts are needed to meet these targets 3.
Treatment and Management
- Standard treatment for latent tuberculosis typically involves a 9-month course of isoniazid, or alternative regimens such as isoniazid and rifapentine for 12 weeks 4, 5.
- Initial therapy for active or suspected tuberculosis usually includes a combination of isoniazid, rifampin, pyrazinamide, and ethambutol 4, 5.
- Treatment for multidrug-resistant tuberculosis requires directly observed therapy with at least 4 susceptible drugs, and the duration of therapy is usually 18-24 months 4.
- Parenteral therapeutic regimens are being explored for critically ill patients or those with a non-functional intestinal tract, but no standardized regimen exists 6.
Global Epidemiology
- The number of persons with TB and TB-related deaths has declined modestly in recent years, but the disease remains a major public health concern 3.
- The WHO South-East Asia and African regions have the highest numbers of incident and prevalent TB cases 3.
- Rifampicin-resistant or multidrug-resistant TB is a significant concern, occurring among 3.4% of persons with new TB and 18% among those previously treated for TB 3.