TY  - CHAP
M1  - Book, Section
TI  - Treatment of Tuberculosis
A1  - Raviglione, Mario C.
A2  - Jameson, J. Larry
A2  - Fauci, Anthony S.
A2  - Kasper, Dennis L.
A2  - Hauser, Stephen L.
A2  - Longo, Dan L.
A2  - Loscalzo, Joseph
PY  - 2018
T2  - Harrison's Principles of Internal Medicine, 20e
AB  - The  two  main  aims  of  TB  treatment  are  (1)  to  prevent  morbidity  and  death  by  curing  TB  while  preventing  the  emergence  of  drug  resistance  and  (2)  to  interrupt  transmission  by  rendering  patients  noninfectious  to  others.  Chemotherapy  for  TB  became  possible  with  the  discovery  of  streptomycin  in  1943.  Randomized  clinical  trials  clearly  indicated  that  the  administration  of  streptomycin  to  patients  with  chronic  TB  reduced  mortality  rates  and  led  to  cure  in  the  majority  of  cases.  However,  monotherapy  with  streptomycin  was  soon  associated  with  the  development  of  resistance  to  this  drug  and  the  resulting  failure  of  treatment.  With  the  introduction  into  clinical  practice  of  para-aminosalicylic  acid  (PAS)  and  isoniazid,  it  became  axiomatic  in  the  early  1950s  that  cure  of  TB  required  the  concomitant  administration  of  at  least  two  agents  to  which  the  organism  was  susceptible.  Furthermore,  early  clinical  trials  demonstrated  that  a  long  period  of  treatment—i.e.,  12–24  months—was  required  to  prevent  recurrence.  The  introduction  of  rifampin  (rifampicin)  in  the  early  1970s  heralded  the  era  of  effective  short-course  chemotherapy,  with  a  treatment  duration  of  <12  months.  The  discovery  that  pyrazinamide,  which  was  first  used  in  the  1950s,  augmented  the  potency  of  isoniazid/rifampin  regimens  led  to  the  use  of  a  6-month  course  of  this  triple-drug  regimen  as  standard  therapy.  Streptomycin  was  added  as  the  fourth  drug  mainly  to  prevent  the  emergence  of  drug  resistance.  These  four  drugs  (with  streptomycin  eventually  replaced  by  ethambutol)  still  form  the  basis  of  the  optimal  treatment  regimen  for  rifampin-susceptible  TB.  The  emergence  of  drug-resistant  TB  in  the  1990s  prompted  attempts  to  standardize  the  approach  to  treatment  of  this  condition  mainly  on  the  basis  of  expert  opinion.  This  event  has  also  stimulated  research  on  and  development  of  new  anti-TB  agents  in  the  past  15  years.  In  2013  and  2014,  respectively,  bedaquiline  and  delamanid—the  first  two  drugs  specifically  developed  for  TB  during  nearly  half  a  century—received  conditional  approval  by  the  U.S.  Food  and  Drug  Administration  (FDA)  and  other  drug-regulatory  authorities;  approval  was  based  on  the  results  of  phase  2b  clinical  trials  in  which  the  drugs  were  added  to  the  18-  to  24-month  WHO-recommended  regimen  for  MDR-TB.  Bedaquiline  and  delamanid  are  being  used  increasingly  for  treatment  of  MDR-TB  under  specific  conditions.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - accesspharmacy.mhmedical.com/content.aspx?aid=1178426755
ER  -