Core Curriculum on Tuberculosis, 2000
Treatment of TB Disease
Persons with Additional Medical Problems
A number of medical conditions may alter immune responsiveness
and predispose a person to TB. Such disorders include HIV infection,
immunosuppressive therapy, hematologic or reticuloendothelial malignancies,
chronic renal failure, diabetes, and malnutrition. These conditions
may influence the outcome of therapy. Therapeutic decisions for
the impaired host must be individualized.
Patients with partial impairment of renal function should avoid
streptomycin, kanamycin, and capreomycin if possible. If renal function
is severely impaired, reduced doses or increased dosing intervals
of other TB drugs may be necessary (see table 7). Measurement of
drug serum levels may be helpful in adjusting the dosage.
For patients who abuse alcohol or who have neuropsychiatric disorders,
close supervision — preferably using DOT — is necessary to ensure
adherence and to monitor for adverse reactions to medications.