CDC Logo Tuberculosis Information CD-ROM   Image of people
     
jump over main navigation bar to content area
Home
TB Guidelines
Surveillance Reports
Slide Sets
TB-Related MMWRs and Reports
Education/Training Materials
Newsletters
Ordering Information
Help

 

U.S. Department of Health and Human Services

  

Education Materials > Publications > Self-Study Modules on TB > Module 4 > Summary

Self-Study Modules on Tuberculosis

This is an archived document. The links are no longer being updated.

Module 4: Treatment of Tuberculosis Infection and Disease

Summary

Preventive therapy is medication that is given to people who have TB infection to prevent them from developing TB disease. High-risk people should be evaluated for preventive therapy if they have a positive skin test reaction, regardless of their age. Others should be evaluated for preventive therapy if they have a positive skin test reaction and they are younger than 35 years old. Sometimes preventive therapy is given to people who have a negative skin test reaction, such as high-risk contacts and children younger than 6 months old who have been exposed to TB.

All patients being considered for preventive therapy should receive a medical evaluation to

  • Exclude the possibility of TB disease
  • Determine whether they have ever been treated for TB infection or disease
  • Identify any medical problems that may complicate therapy or require more careful monitoring

People who are suspected of having TB disease or who have been adequately treated for TB infection or disease should not be given preventive therapy.

The usual regimen for preventive therapy is isoniazid given daily for 6 months. Children should receive 9 months of preventive therapy; HIV-infected persons should receive 12 months. Patients should be evaluated every month for signs of hepatitis and other adverse reactions to isoniazid. They should also be educated about the symptoms caused by adverse reactions to isoniazid and instructed to seek medical attention immediately if these symptoms occur. In addition, people at greatest risk for hepatitis should have liver function tests before starting isoniazid preventive therapy and every month during therapy.

TB disease must be treated for at least 6 months; in some cases, treatment lasts even longer. In most areas of the country, the initial regimen for treating TB disease should include four drugs: isoniazid, rifampin, pyrazinamide, and either ethambutol or streptomycin. When the drug susceptibility results are available, clinicians may change the regimen accordingly. TB disease must be treated with at least two drugs to which the bacilli are susceptible. Using only one drug to treat TB disease can create a population of tubercle bacilli that is resistant to that drug. Drug resistance can also develop when patients do not take treatment as prescribed. Thus, to prevent relapse and drug resistance, clinicians must prescribe an adequate regimen and make sure that patients adhere to treatment. The best way to ensure that patients adhere to treatment is to use directly observed therapy.

There are several options for daily and intermittent treatment. For children with certain types of extrapulmonary TB, pregnant women, and people with drug-resistant TB, treatment may last longer or involve different regimens. Treatment of drug-resistant TB should be done under the supervision of a medical expert who is familiar with the treatment of drug-resistant TB.

All patients being treated for TB disease should be educated about the symptoms caused by adverse reactions to the drugs they are taking and instructed to seek medical attention immediately if they have symptoms of a serious side effect. Patients should be seen by a clinician at least monthly during treatment and evaluated for possible adverse reactions. In addition, before starting treatment, patients should have baseline tests to help clinicians detect any abnormalities that may complicate treatment.

Patients who are not receiving directly observed therapy should be carefully monitored for adherence to treatment. The only way to ensure adherence to treatment is to use directly observed therapy.

To determine whether a patient is responding to treatment, clinicians should do clinical evaluations and bacteriologic evaluations during treatment. Patients should be carefully reevaluated if their

  • Symptoms do not improve during the first 2 months of treatment
  • Symptoms worsen after improving initially
  • Culture results have not become negative after 2 months of treatment
  • Culture results become positive after being negative

In certain situations, clinicians may also use x-rays to monitor a patient's response to treatment.

The treatment of TB can be complicated, especially in patients who fail to respond to treatment, who relapse, or who have drug-resistant TB or adverse reactions to medications. Clinicians who do not have experience with these situations should consult a medical expert.

At each visit with a patient, public health workers should look for signs and symptoms of adverse reactions to the medication. If a patient has symptoms of an adverse reaction, the public health worker should

  • Instruct the patient to stop the medication if the symptoms are serious (before working with TB patients, public health workers should be educated about which symptoms are serious)
  • Report the situation to a clinician and arrange for a medical evaluation right away
  • Note the symptoms on the patient's form

Also, public health workers should pay attention to the patient's improvement. If a patient has symptoms of TB, public health workers should

  • Report the situation to a clinician and arrange for a medical evaluation right away
  • Note the symptoms on the patient's form

Additional Reading

American Lung Association/American Thoracic Society. Treatment of tuberculosis and tuberculosis infection in adults and children. Am J Respir Crit Care Med. 1994;149:1359-1374.

Centers for Disease Control. Management of persons exposed to multidrug-resistant tuberculosis. MMWR. 1992;41(RR-11).

Centers for Disease Control. The use of preventive therapy for tuberculous infection in the United States. MMWR. 1990;39(RR-8).

Core Curriculum on Tuberculosis, 3rd ed. Atlanta: Centers for Disease Control and Prevention; 1994.

 


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

Please send comments/suggestions/requests to: hsttbwebteam@cdc.gov, or to
CDC/Division of Tuberculosis Elimination
Communications, Education, and Behavioral Studies Branch
1600 Clifton Rd., NE - Mailstop E-10, Atlanta, GA 30333