       Document 0334
 DOCN  M9460334
 TI    Treatment of tuberculosis and tuberculosis infection in adults and
       children. American Thoracic Society and The Centers for Disease Control
       and Prevention.
 DT    9408
 AU    Bass JB Jr; Farer LS; Hopewell PC; O'Brien R; Jacobs RF; Ruben F; Snider
       DE Jr; Thornton G
 SO    Am J Respir Crit Care Med. 1994 May;149(5):1359-74. Unique Identifier :
       AIDSLINE MED/94228083
 AB    Treatment of Tuberculosis. 1. A 6-mo regimen consisting of isoniazid,
       rifampin, and pyrazinamide given for 2 mo followed by isoniazid and
       rifampin for 4 mo is the preferred treatment for patients with fully
       susceptible organisms who adhere to treatment. Ethambutol (or
       streptomycin in children too young to be monitored for visual acuity)
       should be included in the initial regimen until the results of drug
       susceptibility studies are available, unless there is little possibility
       of drug resistance (i.e., there is less than 4% primary resistance to
       isoniazid in the community, and the patient has had no previous
       treatment with antituberculosis medications, is not from a country with
       a high prevalence of drug resistance, and has no known exposure to a
       drug-resistant case). This four-drug, 6-mo regimen is effective even
       when the infecting organism is resistant to INH. This recommendation
       applies to both HIV-infected and uninfected persons. However, in the
       presence of HIV infection it is critically important to assess the
       clinical and bacteriologic response. If there is evidence of a slow or
       suboptimal response, therapy should be prolonged as judged on a case by
       case basis. 2. Alternatively, a 9-mo regimen of isoniazid and rifampin
       is acceptable for persons who cannot or should not take pyrazinamide.
       Ethambutol (or streptomycin in children too young to be monitored for
       visual acuity) should also be included until the results of drug
       susceptibility studies are available, unless there is little possibility
       of drug resistance (see Section 1 above). If INH resistance is
       demonstrated, rifampin and ethambutol should be continued for a minimum
       of 12 mo. 3. Consideration should be given to treating all patients with
       directly observed therapy (DOT). 4. Multiple-drug-resistant tuberculosis
       (i.e., resistance to at least isoniazid and rifampin) presents difficult
       treatment problems. Treatment must be individualized and based on
       susceptibility studies. In such cases, consultation with an expert in
       tuberculosis is recommended. 5. Children should be managed in
       essentially the same ways as adults using appropriately adjusted doses
       of the drugs. This document addresses specific important differences
       between the management of adults and children. 6. Extrapulmonary
       tuberculosis should be managed according to the principles and with the
       drug regimens outlined for pulmonary tuberculosis, except for children
       who have miliary tuberculosis, bone/joint tuberculosis, or tuberculous
       meningitis who should receive a minimum of 12 mo of therapy.(ABSTRACT
       TRUNCATED AT 400 WORDS)
 DE    Adolescence  Adult  Antitubercular Agents/ADMINISTRATION &
       DOSAGE/ADVERSE EFFECTS  Child  Human  Tuberculosis/*DRUG
       THERAPY/PREVENTION & CONTROL  Tuberculosis, Multidrug-Resistant/DRUG
       THERAPY  GUIDELINE  JOURNAL ARTICLE  PRACTICE GUIDELINE

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

