Tuberculosis Treatment Strategies in the US

To mark World TB Day, a pair of experts break down the currently defined regimens for latent and active tuberculosis—and what may still come.

Today, March 24, marks World TB Day, the date reflecting Dr. Robert Koch’s discovery of Mycobacterium tuberculosis in 1882.

In recognition of the annual medical holiday, our sister publication HCPLive hosted a podcast interview between American Lung Association (ALA) Al Rizzo, MD, and Philip LoBue, MD, Director of Tuberculosis Elimination at the US Centers for Disease Control and Prevention (CDC) National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.

Among their topics of discussion on the history and current state of TB elimination in the US was the actual treatment of the respiratory infection.

As LoBue noted, the disparity of tuberculosis treatment strategy depends on its status in a patient: latent, or active. Latent TB generally requires 1-2 therapies for a shorter period of time, prescribed in 3 different regimens:

  1. 3 months of once-weekly isoniazid (INH) plus rifampin (RIF)
  2. 4 months of RIF daily
  3. 3 months of daily combination INH and RIF

“Those are all very effective—probably more than 90% effective,” LoBue explained.

Active disease, meanwhile, is more difficult to treat and requires more complicated regimens. Treatment will generally run 6-9 months, LoBue said, and include any of 4 therapies:

  1. INH
  2. RIF
  3. Ethambutol (EMB)
  4. Pyrazinamide (PZA)

Among the most promising developments in TB care is the hopeful reduction of active tuberculosis care, from 6 to 4 months, with the addition of moxifloxacin.

In the meantime, however, LoBue stressed the significance of state-set care teams and at-risk patients adhering to what’s understood to benefit either form of tuberculosis—in order to avoid a worse form of the disease.

“If all the doses of medication are not taken correctly, not only is there a good chance that the person will fail their treatment and not get better, but it puts them at great risk to develop drug-resistant TB, which is much more difficult to treat,” he said.

Lungcast is a monthly podcast series from HCPLive and the ALA. Listen to the full episode here:

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