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U.S. Department of Health and Human Services

  

Core Curriculum on Tuberculosis, 2000

Chapter 7
Treatment of TB Disease

Regimens

Extrapulmonary TB

As a general rule, regimens that are adequate for treating pulmonary TB in adults and children are also effective for treating extrapulmonary disease. However, infants and children who have miliary TB, bone and joint TB, or TB meningitis should receive a minimum of 12 months of therapy.

The use of adjunct therapies such as surgery and corticosteroids is more commonly required for extrapulmonary TB than for pulmonary disease. Surgery may be necessary to obtain specimens for diagnosis and to treat such processes as constrictive pericarditis and spinal cord compression from Pott’s disease. Corticosteroids have been shown to be beneficial in preventing cardiac constriction from tuberculous pericarditis 15 and in decreasing the neurologic sequelae of all stages of TB meningitis, 16 especially when administered early in the course of disease.

In patients with extrapulmonary TB, the type of follow-up examinations should be determined by the site of the disease. Bacteriologic evaluation may be limited by the relative inaccessibility of the site. Thus, the response to treatment must often be judged on the basis of clinical and radiologic findings.

TB Treatment for HIV-Positive Patients with Extrapulmonary TB
The basic principles that support the treatment of pulmonary TB in HIV-positive patients also apply to extrapulmonary forms of the disease. Most extrapulmonary forms of TB (including TB meningitis, tuberculous lymphadenitis, pericardial TB, pleural TB, and disseminated or miliary TB) are more common among persons with advanced-stage HIV disease than among patients with asymptomatic HIV infection. The drug regimens and treatment durations that are recommended for treating pulmonary TB in HIV-positive adults and children are also recommended for treating most patients with extrapulmonary disease. However, for certain forms of extrapulmonary disease, such as meningioma, bone TB, and joint TB, using a standard rifamycin-based regimen for at least 9 months is generally recommended.

 


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination - http://www.cdc.gov/tb

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