       Document 0498
 DOCN  M9460498
 TI    Infection caused by Mycobacterium tuberculosis.
 DT    9404
 AU    Peloquin CA; Berning SE; Infectious Disease Pharmacokinetics Laboratory
       (IDPL), National; Jewish Center for Immunology and Respiratory Medicine,
       Denver, CO; 80206.
 SO    Ann Pharmacother. 1994 Jan;28(1):72-84. Unique Identifier : AIDSLINE
       MED/94169505
 AB    OBJECTIVE: To update readers on the clinical management of infections
       caused by Mycobacterium tuberculosis, to provide a general description
       of the organism, culture and susceptibility testing, and clinical
       manifestations of the disease, and to provide several aspects of the
       treatment of the disease, including historical perspective, current
       approaches, and research opportunities for the future. DATA SOURCES: The
       current medical literature, including abstracts presented at recent
       international meetings, is reviewed. References were identified through
       MEDLINE, MEDLARS II, Current Contents, and published meeting abstracts.
       STUDY SELECTION: Data regarding the epidemiology, clinical
       manifestations, culture and susceptibility testing, and treatment of
       tuberculosis are cited. Specific attention has been focused on the
       clinical management of patients with noncontagious infection and
       potentially contagious active disease (TB) caused by M. tuberculosis.
       DATA EXTRACTION: Information contributing to the discussion of the
       topics selected by the authors is reviewed. Data supporting and
       disputing specific conclusions are presented. DATA SYNTHESIS: The
       incidence of TB is increasing in the US, despite the fact that available
       technologies are capable of controlling the vast majority of existing
       cases. Fueling the fire is the problem of coinfection with HIV and M.
       tuberculosis. Very few drugs are available for the treatment of TB, and
       few of these approach the potency of isoniazid and rifampin. Preventive
       therapy of patients exposed to multiple-drug-resistant M. tuberculosis
       (MDR-TB) is controversial and of unknown efficacy. Treatment of active
       disease caused by MDR-TB requires up to four times longer, is associated
       with increased toxicity, and is far less successful than the treatment
       of drug-susceptible TB. Strategies for the management of such cases are
       presented. The rising incidence of TB in the US reflects a breakdown in
       the healthcare systems responsible for controlling the disease, which
       reflects the past budgetary reductions. Although TB control is one of
       the most cost-effective public health strategies, funding has been cut
       repeatedly despite the fact that TB was never eliminated. This has
       helped to produce the current crisis, including the spread of MDR-TB in
       many urban areas. The elimination of TB will now take decades longer,
       cost hundreds of millions of dollars more, and result in vastly higher
       morbidity and mortality rates than would have occurred with timely,
       adequate measures. CONCLUSIONS: Tremendous effort and far more funding
       will be required to eliminate TB in the US. The selection of drug
       therapy must be based on the susceptibility data for each isolate.
       Multiple-drug therapy must be continued for 6 to > or = 24 months, and
       patient adherence to prescribed regimens must be verified in all cases
       of TB. Significant antimycobacterial drug malabsorption has been
       documented in AIDS patients with TB, and may result in treatment
       failure. New agents are needed to improve the clinical outcome in
       patients with MDR-TB.
 DE    Adult  Anti-Infective Agents, Fluoroquinolone/ADVERSE EFFECTS/
       THERAPEUTIC USE  Antitubercular Agents/ADVERSE EFFECTS/*THERAPEUTIC USE
       Child  Child, Preschool  Drug Delivery Systems  Human  *Mycobacterium
       tuberculosis/DRUG EFFECTS/ISOLATION & PURIF  Rifamycins/ADVERSE
       EFFECTS/THERAPEUTIC USE  Tuberculin Test  Tuberculosis/DIAGNOSIS/*DRUG
       THERAPY/MICROBIOLOGY/TRANSMISSION  Tuberculosis,
       Pulmonary/DIAGNOSIS/*DRUG THERAPY/MICROBIOLOGY/  TRANSMISSION  JOURNAL
       ARTICLE  REVIEW  REVIEW, TUTORIAL

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

