Tuberculosis

Treatment of tuberculosis was extensively reviewed in a statement by the American Thoracic Society and the Center for Disease Control and Prevention in March 1993. In summary, a 6-month regimen consisting of isoniazid (5 mg/kg once daily) rifampin (10 mg/kg once daily), and pyrazinamide (15 mg/kg once daily) should be given for 2 months, followed by isoniazid and rifampin for 4 months for patients with fully susceptible organisms who adhere to treatment. In cases of non-conversion of cultures after the initial 2-month regimen, the two-drug regimen of the continuation phase should be extended for 6 to 7 months after cultures are negative. Ethambutol (15 mg/kg) should be included in the first regimen if there is a risk of drug resistance (i.e. previous antituberculous treatment, contact with a drug-resistant case, country with a high prevalence of drug resistance) until the results of drug susceptibility studies are available. Alternatively, a 9-month regimen with rifampin and isoniazid is acceptable for patients who cannot or should not take pyrazinamide. In cases of isoniazid resistance, a 12-month regimen with rifampin and ethambutol is recommended.

In adults, extrapulmonary tuberculosis is treated in a similar manner and with the same regimen as for pulmonary tuberculosis.

Most of the severe cases of tuberculosis requiring admission to the ICU have a disseminated form of the disease and frequently miliary tuberculosis. Steroids have been shown to be effective in preventing cardiac constriction from tuberculous pericarditis and in decreasing the neurological sequelae of all stages of tuberculous meningitis. Corticosteroids are frequently used for severe miliary tuberculosis with acute respiratory distress syndrome and are probably lifesaving.

Amikacin, quinolones, rifabutin, rifapentene, and clofazimine are potentially effective drugs against tuberculosis.

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