- Tuberculosis (TB) is the most prevalent communicable infectious disease on earth. It is the leading cause of death in human immunodeficiency virus (HIV) infection worldwide. It remains out of control in many developing nations. These nations require medical and financial assistance from developed nations in order to control the spread of TB globally.
- In the United States, TB disproportionately affects ethnic minorities as compared with whites, reflecting greater ongoing transmission in ethnic minority communities. Additional TB surveillance and preventive treatment are required within these communities.
- Coinfection with HIV and TB accelerates the progression of both diseases, thus requiring rapid diagnosis and treatment of both diseases.
- Mycobacteria are slow-growing organisms; in the laboratory, they require special stains, special growth media, and long periods of incubation to isolate and identify.
- TB can produce atypical signs and symptoms in infants, the elderly, and immunocompromised hosts, and it can progress rapidly in these patients.
- Latent TB infection (LTBI) can lead to reactivation disease years after the primary infection occurred.
- The patient suspected of having active TB disease must be isolated until the diagnosis is confirmed and the patient is no longer contagious. Often, isolation takes place in specialized “negative-pressure” hospital rooms to prevent the spread of TB.
- Isoniazid and rifampin are the two most important TB drugs; organisms resistant to both these drugs (multidrug-resistant TB [MDR-TB]) are much more difficult to treat.
- Directly observed treatment (DOT) is considered the standard of care. DOT should be used whenever possible to reduce treatment failures and the selection of drug-resistant isolates.
- Never add a single drug to a failing TB treatment regimen!
On completion of the chapter, the reader will be able to:
Identify the risk factors for TB infection and active disease.
Design an appropriate therapeutic plan for latent tuberculosis in immunocompetent, immunocompromised, and special patient populations.
Design an appropriate therapeutic plan for active tuberculosis in immunocompetent, immunocompromised, and special patient populations.
Distinguish between the diagnostic tests used for patients potentially infected with tuberculosis.
Identify the common adverse effects associated with medications used for the treatment of tuberculosis.
Implement an alternative therapeutic plan for patients with tuberculosis who are experiencing adverse drug reactions or not responding to therapy.
Implement an alternative therapeutic plan for patients with tuberculosis who are at risk of or are experiencing clinically significant drug interactions.
Formulate a monitoring plan for a patient being treated for latent or active TB.
Select patients for whom therapeutic drug monitoring may be valuable and identify the necessary laboratory monitoring parameters for patients on antituberculosis medications.
Tuberculosis (TB) remains a leading infectious killer globally. TB is caused by Mycobacterium tuberculosis, which can produce either a silent, latent infection or a progressive, active disease.1 Left untreated or improperly treated, TB causes progressive tissue destruction and, eventually, death. Because of renewed public health efforts, TB rates in the United States continue to decline. In contrast, TB remains out of control in many developing countries—to ...