Core Curriculum on Tuberculosis, 2000
Treatment of TB Disease
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
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
and in decreasing the neurologic sequelae of all stages of TB meningitis,
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
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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