Tuberculosis management describes the techniques and procedures utilized in treating tuberculosis (TB). The medical standard for active TB is a short course treatment involving a combination of Isoniazid, Rifampicin (also known as Rifampin), Pyrazinamide, and Ethambutol for the first two months. During this initial period, Isoniazid is taken alongside Pyridoxal phosphate to obviate Peripheral neuropathy. Isoniazid is then taken coicident with Rifampicin alone for the remaining four months of treatment. A patient is considered free of all living TB bacteria after six months. Latent tuberculosis or Latent Tuberculosis Infection (LTBI) is treated with three to nine months of Isoniazid alone, this longterm treatment often risks the development of Hepatotoxicity. A combination of Isoniazid plus Rifampicin for a period of three to four months is shown to be an equallly effective method for treating LTBI, while mitigating risks to Hepatotoxicity. Treatment of LTBI is essential in preventing the spread of active TB. Drugs
First line
All first-line anti-tuberculous drug names have semistandardized three-letter and single-letter abbreviations:
ethambutol is EMB or E,
isoniazid is INH or H,
pyrazinamide is PZA or Z,
rifampicin is RMP or R,
streptomycin is SM or S.First-line anti-tuberculous drug names are often remembered with the mnemonic "RIPE," referring to the use of a rifamycin (like rifampin), isoniazid, pyrazinamide, and ethambutol. US practice uses abbreviations and names that are not internationally convened: rifampicin is called rifampin and abbreviated RIF; streptomycin is abbreviated STM.
An example might be a close contact of a patient known to have a fully sensitive strain of tuberculosis: in this case, it is acceptable to use 2HRZ/4HR (omitting EMB and STM) in the expectation that their strain will be INH susceptible also. Indeed, this was previously the recommended standard regimen in many countries until the early 1990s, when isoniazid-resistance rates increased. TB involving the brain or spinal cord (meningitis, encephalitis, etc.) is currently treated with 2HREZ/10HR (12 months of treatment in total), but there is no evidence to say that this is superior to 2HREZ/4HR. There is no difference in relapse rates amongst those who are treated with 6 months or longer period of time. However, more well-designed studies are needed to answer this question. Regimens omitting isoniazid
Isoniazid resistance accounts 6.9% of isolates in the UK (2010). Worldwide, it is the most common type of resistance encountered, hence the current recommendation of using HREZ at the beginning of treatment until sensitivities are known. It is useful to know of current reported outbreaks (like the current outbreak of INH-resistant TB in London). If patients are discovered to be infected with an isoniazid-resistant strain of TB having completed 2 months of HREZ, then they should be changed to RE for a further 10 months, and the same thing if the patient is intolerant to isoniazid (although 2REZ/7RE may be acceptable if the patient is well supervised). The US recommendation is 6RZE with the option of adding a quinolone such as moxifloxacin.