Tuberculosis (TB) - Treatment & Care (medical)
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Publications
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| Chemotherapy and management of tuberculosis in the United Kingdom: recommendations 1998 | Joint Tuberculosis Committee of the British Thoracic Society | Thorax 1998;53:536–548 | 536–548 |
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| Abstract Background—The guidelines on chemotherapy and management of tuberculosis in the United Kingdom have been reviewed and updated. Methods—A subcommittee was appointed by the Joint Tuberculosis Committee (JTC) of the British Thoracic Society to revise the guidelines published in 1990 by the JTC. In preparing the revised guidelines the authors took account of new published evidence and graded the strength of evidence for their recommendations. The guidelines have been approved by the JTC and the Standards of Care Committee of the British Thoracic Society. Recommendations—(1) Patients with tuberculosis should be notified. (2) In view of the rising incidence of drug resistance, bacteriological confirmation and drug susceptibility testing should be sought whenever possible. (3) A six month short course regimen, with four drugs in the initial phase, should be used for all forms of tuberculosis, except meningitis, in both adults and children. (4) The fourth drug (ethambutol) in the initial phase can be omitted in certain circumstances. (5) Treatment of all patients should be supervised by physicians with full training in the management of tuberculosis and with direct working access to tuberculosis nurse specialists or health visitors. (6) Advice is given on (a) management in special situations and patient groups, (b) drug interactions, and special precautions and pretreatment screening, (c) chemoprophylaxis for different groups, and (d) the management of single and multiple drug resistance. (7) Advice is given on follow up after treatment and the organisational framework for tuberculosis services. (8) The role of directly observed therapy is discussed. (9) The management of multidrug resistant tuberculosis is explained in outline: such patients should be managed by physicians with special experience and in close liaison with the Mycobacterium Reference Units, and in hospitals with appropriate isolation facilities. (10) Infection control and segregation for such patients and for patients with dual infection with human immunodeficiency virus (HIV) and tuberculosis are covered in an appendix. | |||||
| Treatment of Tuberculosis: Guidelines (4th Edition) | WHO | 65-72 |
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| Use of the new WHO process for evidence-based guidelines revealed many key unanswered questions. What is the best way to treat isoniazid-resistant TB and prevent MDR? What is the optimal duration of TB treatment in HIV-positive patients? Which patients are most likely to relapse and how can they be detected and treated? Identification of such crucial questions for the future research agenda is an important outcome of this revision and will require careful follow-up to ensure that answers will be provided to further strengthen TB care practices. | |||||
| Timing of Initiation of Antiretroviral Drugs during Tuberculosis Therapy | S Abdool Karim et al. | NEJM | 697-706 |
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| Background The rates of death are high among patients with coinfection with tuberculosis and the human immunodeficiency virus (HIV). The optimal timing for the initiation of antiretroviral therapy in relation to tuberculosis therapy remains controversial. Methods In an open-label, randomized, controlled trial in Durban, South Africa, we assigned 642 patients with both tuberculosis and HIV infection to start antiretroviral therapy either during tuberculosis therapy (in two integrated-therapy groups) or after the completion of such treatment (in one sequential-therapy group). The diagnosis of tuberculosis was based on a positive sputum smear for acid-fast bacilli. Only patients with HIV infection and a CD4+ cell count of less than 500 per cubic millimeter were included. All patients received standard tuberculosis therapy, prophylaxis with trimethoprim–sulfamethoxazole, and a once-daily antiretroviral regimen of didanosine, lamivudine, and efavirenz. The primary end point was death from any cause. Results This analysis compares data from the sequential-therapy group and the combined integrated-therapy groups up to September 1, 2008, when the data and safety monitoring committee recommended that all patients receive integrated antiretroviral therapy. There was a reduction in the rate of death among the 429 patients in the combined integrated-therapy groups (5.4 deaths per 100 person-years, or 25 deaths), as compared with the 213 patients in the sequential-therapy group (12.1 per 100 person-years, or 27 deaths); a relative reduction of 56% (hazard ratio in the combined integrated-therapy groups, 0.44; 95% confidence interval, 0.25 to 0.79; P = 0.003). Mortality was lower in the combined integrated-therapy groups in all CD4+ count strata. Rates of adverse events during follow-up were similar in the two study groups. Conclusions The initiation of antiretroviral therapy during tuberculosis therapy significantly improved survival and provides further impetus for the integration of tuberculosis and HIV services. (ClinicalTrials.gov number, NCT00398996.) | |||||
| Treatment of Tubercuilosis Guidelines | World Health Organization | 1-160 |
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| Key Changes Since the Third Edition: • The scope is now limited to treatment of TB in adults. The fourth edition no longer covers: — TB case detection and diagnosis; — diagnosis and treatment of TB in children (WHO has published a separate guideline on management of childhood TB); — drug supply management. • Instead of “Diagnostic categories I–IV”, this edition uses the same patient regis- tration groups used for recording and reporting, which differentiate new patients from those with prior treatment and specify reasons for retreatment. • Each applicable standard from the International Standards for TB Care is cross- referenced. • An expiry date is provided. | |||||
| Партнеры во имя здоровья | Партнеры во имя здоровья | 1-97 |
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| Руководстов на русском языке по ведению больных с лекарственно-устойчивым туберкуолезом | |||||
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