eMedicine Specialties > Infectious Diseases > Mycobacterial Infections
Tuberculosis: Treatment & Medication
Updated: Nov 11, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
- For initial empiric treatment of tuberculosis (TB), start patients on a 4-drug regimen: isoniazid, rifampin, pyrazinamide, and either ethambutol or streptomycin. Once the TB isolate is known to be fully susceptible, ethambutol (or streptomycin if used as a fourth drug) can be discontinued.
- After 2 months of therapy (for a fully susceptible isolate), pyrazinamide can be stopped. Isoniazid plus rifampin are continued as daily or intermittent therapy for 4 more months.
- If isolated isoniazid resistance is documented, discontinue isoniazid and continue treatment with rifampin, pyrazinamide, and ethambutol for the entire 6 months.
- Therapy must be extended if the patient has cavitary disease or remains culture-positive after 2 months of treatment.
- Directly observed therapy (DOT) is recommended for all patients. Patients on the above regimens as DOT can be switched to 2- to 3-times per week dosing after an initial 2 weeks of daily dosing. Patients on twice-weekly dosing must not miss any doses. Prescribe daily therapy for patients on self-administered medication.
- The diagnosis of MDR-TB is established with an isolate that is resistant to both isoniazid and rifampin. Resistance may be initial (no known history of prior treatment) or secondary (acquired during therapy or because of previous inadequate therapy).
- Risk factors for initial resistance include exposure to a patient who has MDR-TB or being from a country or region with a high prevalence of resistance. Symptoms and radiographic findings do not differentiate MDR-TB from fully susceptible TB. Suspect MDR-TB if the patient is on DOT with the 4 first-line drugs (no diarrhea) and symptoms do not improve within 1-2 weeks.
- Continue treatment for MDR-TB for 18-24 months after sputum culture conversion. The drugs should be prescribed daily (no intermittent therapy), and the patient should always be on DOT. Weekend DOT may not be possible; therefore, giving self-administered oral drugs on Saturdays and Sundays may be reasonable. Consult an expert on MDR-TB. Costs are many times higher for treatment of MDR-TB. Treatment should include an injectable drug together with at least 3 more drugs to which the isolate is susceptible.
- In a phase 2, randomized, controlled trial, Diacon et al studied patients with newly diagnosed multidrug-resistant pulmonary TB. Forty-seven patients were assigned either TMC207 (400 mg PO qd for 2 wk, then 200 mg tid for 6 wk) or placebo in combination with a standard 5-drug, second-line antituberculosis regimen. TMC207 added to standard therapy for MDR-TB reduced the time to conversion to a negative sputum culture compared with placebo (P = 0.003) and increased the proportion of patients with conversion of sputum culture (48% vs 9%). These data provide important results to continue investigation of TMC207 in a larger population for multidrug-resistant pulmonary TB.15
- The diagnosis of extended drug-resistant TB (XDR-TB) is established with an isolate that is resistant to isoniazid, rifampin, at least one of the quinolones, and at least one injectable drug. Treatment options for XDR-TB are very limited, and XDR-TB carries a very high mortality rate.
Surgical Care
- Surgical resection of an infected lung may be considered to reduce the bacillary burden in patients with MDR-TB. Procedures include segmentectomy (rarely used), lobectomy, and pneumonectomy. Pleurectomies for thick pleural peel are rarely indicated. However, intraoperative infection of uninvolved lung tissue has been observed.
- Complications include the usual perioperative complications, recurrent disease, and bronchopleural fistulas.
Consultations
- Infectious disease specialist
- Pulmonologist
- General or thoracic surgeon
Activity
Smoking has been shown to be a risk factor for TB; smokers who develop TB should be encouraged to stop smoking to decrease the risk of relapse.16
Medication
The goals of pharmacotherapy are to reduce morbidity and to prevent complications.
Antimycobacterials
The goals of tuberculosis (TB) treatment are to shorten the clinical course, to prevent complications, to prevent the development of latency and/or subsequent recurrences, and to decrease the likelihood of TB transmission. In patients with latent TB, the goal of therapy is to prevent progression of disease.
Isoniazid (Laniazid)
DOC for preventive therapy and primary drug in combination therapy for active TB. In patients receiving treatment for active TB, pyridoxine 25-50 mg PO qd should be coadministered to prevent peripheral neuropathy.
Adult
300 mg PO qd
Pediatric
10 mg/kg/d PO qd; not to exceed 300 mg/d
Higher incidence of isoniazid-related hepatitis can occur with daily alcohol ingestion; aluminum salts may decrease isoniazid serum levels (administer 1-2 h before taking aluminum salts); may increase effects of anticoagulants with coadministration; may inhibit metabolic clearance of benzodiazepines
Carbamazepine toxicity or isoniazid hepatotoxicity may result from concurrent use (monitor carbamazepine concentrations and liver function); coadministration with cycloserine may increase adverse CNS effects (eg, dizziness); acute behavioral and coordination changes may occur with coadministration of disulfiram
Coadministration with rifampin after halothane anesthesia may result in hepatotoxicity and hepatic encephalopathy; may inhibit hepatic microsomal enzymes and increase toxicity of hydantoin
Documented hypersensitivity; previous isoniazid-associated hepatic injury; other severe adverse reactions
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Monitor patients with active chronic liver disease or severe renal dysfunction; periodic ophthalmologic examinations during isoniazid therapy are recommended even when visual symptoms do not occur
Rifampin (Rifadin, Rimactane)
For use in combination with at least one other antituberculous drug. Inhibits DNA-dependent bacterial but not mammalian RNA polymerase. Cross-resistance may occur.
Treat for 6 mo for most susceptible cases; 9 mo if sputum culture result is still positive after 2 mo of treatment.
Adult
600 mg PO qd
Pediatric
10-20 mg/kg/d PO qd; not to exceed 600 mg/d
Induces microsomal enzymes, which may decrease effects of acetaminophen, PO anticoagulants, barbiturates, benzodiazepines, beta-blockers, chloramphenicol, PO contraceptives, corticosteroids, mexiletine, cyclosporine, digitoxin, disopyramide, estrogens, hydantoins, methadone, clofibrate, quinidine, dapsone, tazobactam, sulfonylureas, theophyllines, tocainide, and digoxin; blood pressure may increase with coadministration of enalapril; coadministration with isoniazid may result in higher rate of hepatotoxicity than with either agent alone (discontinue one or both agents if alterations in LFTs occur)
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Obtain CBCs and baseline clinical chemistries before and throughout therapy; in liver disease, weigh benefits against risk of further liver damage; interruption of therapy and high-dose intermittent therapy are associated with thrombocytopenia that is reversible if therapy is discontinued as soon as purpura occurs; if treatment is continued or resumed after appearance of purpura, cerebral hemorrhage or death may occur
Pyrazinamide (PZA)
Pyrazine analog of nicotinamide that may be bacteriostatic or bactericidal against M tuberculosis depending on concentration of drug attained at site of infection; mechanism of action is unknown.
Administer for initial 2 mo of a 6-mo or longer treatment regimen for drug-susceptible TB. Treat drug-resistant TB with individualized regimens.
Adult
<50 kg: 1.5 g PO qd
50-75 kg: 2 g PO qd
>75 kg: 2.5 g PO qd
Pediatric
15-30 mg/kg/d PO qd; not to exceed 2 g/d
None reported
Documented hypersensitivity; severe hepatic damage; acute gout
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Use only in combination with other effective antituberculous agents; inhibits renal excretion of urates; may result in hyperuricemia (usually asymptomatic); perform baseline serum uric acid determinations; discontinue drug if signs of hyperuricemia with acute gouty arthritis occur; perform baseline LFTs (closely monitor in liver disease); discontinue pyrazinamide if signs of hepatocellular damage appear; caution in history of diabetes mellitus
Ethambutol (Myambutol)
Diffuses into actively growing mycobacterial cells (eg, tubercle bacilli). Impairs cell metabolism by inhibiting synthesis of one or more metabolites, which in turn, causes cell death. No cross-resistance demonstrated.
Mycobacterial resistance is frequent with previous therapy. Use in these patients in combination with second-line drugs that have not been previously administered. Administer q24h until permanent bacteriological conversion and maximal clinical improvement are observed. Absorption is not significantly altered by food.
Adult
15-25 mg/kg PO qd
Pediatric
Administer as in adults
Aluminum salts may delay and reduce absorption (administered several hours before or after ethambutol dose)
Documented hypersensitivity; optic neuritis (unless clinically indicated)
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Reduce dose in impaired renal function; may have reversible adverse visual effects if promptly discontinued
Streptomycin sulfate
For treatment of susceptible mycobacterial infections. Use in combination with other antituberculous drugs (eg, isoniazid, ethambutol, rifampin). Total period of treatment for TB is a minimum of 6 mo; however, streptomycin therapy is not commonly used for the duration of therapy. Recommended when less potentially hazardous therapeutic agents are ineffective or contraindicated.
Adult
15 mg/kg IM qd; can be administered 3-5 d/wk
Pediatric
20-30 mg/kg IM qd
Nephrotoxicity may be increased with aminoglycosides, cephalosporins, penicillins, amphotericin B, and loop diuretics
Documented hypersensitivity; non–dialysis-dependent renal insufficiency
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Narrow therapeutic index; not intended for long-term therapy; caution in renal failure, patient not taking dialysis; caution with myasthenia gravis, hypocalcemia, and conditions that depress neuromuscular transmission
Levofloxacin (Levaquin)
Second-line drug. Useful in the treatment of TB in combination with rifampin and other antituberculous agents. Useful in treating most cases of MDR-TB.
Adult
500-1000 mg PO qd
Pediatric
<18 years: Not recommended unless no alternates available
Antacids, iron salts, and zinc salts may reduce serum levels; administer antacids 2-4 h before or after taking fluoroquinolones; cimetidine may interfere with metabolism of fluoroquinolones; reduces therapeutic effects of phenytoin; probenecid may increase serum concentrations; may increase toxicity of theophylline, caffeine, cyclosporine, and digoxin (monitor digoxin levels); may increase effects of anticoagulants (monitor PT)
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
In prolonged therapy, perform periodic evaluations of organ system functions (eg, renal, hepatic, hematopoietic); adjust dose in renal function impairment; superinfections may occur with prolonged or repeated antibiotic therapy
Rifapentine (Priftin)
Used in once-weekly regimens along with isoniazid. Should not be used in individuals with HIV or with positive cultures after 2 mo of treatment.
Adult
600 mg PO qwk during the continuation phase of treatment for TB; given in combination with isoniazid for susceptible organism
Pediatric
Not established
Induces cytochrome P 4503 A 4 and P 4502 C 8/9, thereby decreasing levels of other drugs that are metabolized by these enzymes; may decrease plasma concentration of calcium channel blockers (verapamil, nifedipine, diltiazem), methadone, oral anticoagulants, oral contraceptives, benzodiazepines, acetaminophen, dapsone, clofibrate, doxycycline, levothyroxine, nortriptyline, tacrolimus, zidovudine, protease inhibitors, hydantoins, sulfa drugs, or enalapril; toxicity may increase when taken concurrently with halothane or isoniazid
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Adverse effects include serious hepatic events, including hepatitis and liver failure; Clostridium difficile -associated colitis; hyperbilirubinemia; urticaria; thrombocytopenia; hyperkalemia; fatigue; gout; may cause red-orange discoloration of body fluids (eg, tears, urine, sweat, CSF)
Para-aminosalicylic acid (Sodium PAS)
Second-line drug. Bacteriostatic agent useful against M tuberculosis. Inhibits the onset of bacterial resistance to streptomycin and isoniazid. Administer aminosalicylate sodium with other antituberculous drugs.
Adult
4-6 g PO bid
Pediatric
75 mg/kg PO bid
PO absorption of digoxin may be reduced, causing a reduction in serum levels when administered concurrently with PAS; increase in digoxin dosing may be necessary; a deficiency in vitamin B-12 (PO) may be induced because of PAS interference of its GI absorption; parenteral vitamin B-12 supplementation may be required
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Caution in gastric ulcer and history of congestive heart failure; avoid situations in which excess sodium is potentially harmful
Ethionamide (Trecator-SC)
Second-line drug. Bacteriostatic against M tuberculosis. Recommended if treatment with first-line drugs (isoniazid, rifampin) is unsuccessful. Treats any form of active TB. However, should only be used with other effective antituberculous agents.
Adult
250-500 mg PO bid
Pediatric
15-20 mg/kg PO bid
Hepatotoxicity increases when used concurrently with rifampin
Documented hypersensitivity; severe hepatic damage
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Make determinations of serum transaminase (AST, ALT) prior to therapy and q2-4wk thereafter; perform in vitro susceptibility tests of recent cultures of M tuberculosis from patient, with ethionamide and usual first-line antituberculous drugs; management of diabetes mellitus may be more difficult, and hepatitis may occur more frequently
Amikacin (Amikin)
Second-line drug. Irreversibly binds to 30S subunit of bacterial ribosomes; blocks recognition step in protein synthesis; causes growth inhibition. Use patient's IBW for dosage calculation.
Adult
15 mg/kg IM qd; can administer 3-5 d/wk
Pediatric
15-30 mg/kg IM qd
Coadministration with other aminoglycosides, penicillins, cephalosporins, and amphotericin B (increases nephrotoxicity); enhances effects of neuromuscular-blocking agents; causes respiratory depression; irreversible hearing loss may occur with coadministration of loop diuretics
Documented hypersensitivity
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Not intended for long-term therapy; caution in patients with renal failure (patient not taking dialysis), hypocalcemia, myasthenia gravis, and conditions that depress neuromuscular transmission
Cycloserine (Seromycin)
Second-line drug. Inhibits cell wall synthesis in susceptible strains of gram-positive and gram-negative bacteria and in M tuberculosis. Structural analogue of D -alanine, which antagonizes role of D -alanine in bacterial cell wall synthesis, inhibiting growth.
Adult
250-500 mg PO bid
Pediatric
10-20 mg/kg PO bid
Incompatible with alcohol consumption because may increase possibility and risk of epileptic episodes; isoniazid in combination with cycloserine may result in increased adverse cycloserine CNS effects (eg, dizziness)
Documented hypersensitivity; severe anxiety or psychosis; epilepsy; depression; severe renal insufficiency; alcoholism; severe neurologic impairments
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Discontinue drug or reduce dosage if allergic dermatitis or symptoms of CNS toxicity (eg, convulsions, headache, tremor, depression, confusion, psychosis, somnolence, hyperreflexia, vertigo, paresis, or dysarthria) develop; risk of convulsions is increased in long-term alcoholism; administration has been associated with vitamin B-12 and folic acid deficiency, megaloblastic anemia, and sideroblastic anemia; monitor blood levels weekly in reduced renal function, patients receiving >500 mg/d, and patients with symptoms of toxicity
Capreomycin (Capastat)
A second-line drug. Obtained from Streptomyces capreolus for coadministration with other antituberculous agents in pulmonary infections caused by capreomycin-susceptible strains of M tuberculosis. For use only when first-line agents (eg, isoniazid, rifampin) have been ineffective or cannot be used because of toxicity or presence of resistant tubercle bacilli.
Adult
15 mg/kg IM qd; also administered as IV infusion
Pediatric
15-30 mg/kg IM qd
Coadministration with aminoglycosides may increase risk of respiratory paralysis and renal dysfunction; with nondepolarizing neuromuscular-blocking agents, has synergistic effects on myoneural function
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Assess vestibular auditory function prior to therapy and regularly while treating; monitor renal function throughout treatment (reduce dose in renal impairment); monitor serum potassium levels
Rifabutin (Mycobutin)
Ansamycin antibiotic derived from rifamycin S. Inhibits DNA-dependent RNA polymerase, preventing chain initiation. Used in treatment for TB in individuals on specific HIV medications, when rifampin is contraindicated (most protease inhibitors).
Adult
300 mg PO qd; as part of an intermittent regimen, 300 mg PO 3 times/wk
Pediatric
Not established; suggested dose is 5 mg/kg/d PO
Decreases plasma concentration of methadone, verapamil, cyclosporine, digoxin, corticosteroids, oral anticoagulants, barbiturates, theophylline, quinidine, halothane, protease inhibitors, non-nucleoside reverse transcriptase inhibitors, oral contraceptives, ketoconazole, and chloramphenicol; toxicity of rifabutin increases when administered concurrently with indinavir, ketoconazole, itraconazole, ritonavir, erythromycin, or protease inhibitors
Documented hypersensitivity; WBC count <1000/μL or platelet count <50,000/μL
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Perform hematologic studies periodically due to association with neutropenia, and more rarely thrombocytopenia
More on Tuberculosis |
| Overview: Tuberculosis |
| Differential Diagnoses & Workup: Tuberculosis |
 Treatment & Medication: Tuberculosis |
| Follow-up: Tuberculosis |
| Multimedia: Tuberculosis |
| References |
| « Previous Page | Next Page » |
References
World Health Organization. Global tuberculosis control report – surveillance, planning, finance. WHO report 2008. World Health Organization. Available at http://www.who.int/tb/publications/global_report/en/index.html. Accessed March 27, 2008.
Wells CD, Cegielski JP, Nelson LJ, et al. HIV infection and multidrug-resistant tuberculosis: the perfect storm. J Infect Dis. Aug 15 2007;196 Suppl 1:S86-107. [Medline].
[Best Evidence] Burman WJ, Goldberg S, Johnson JL, et al. Moxifloxacin versus ethambutol in the first 2 months of treatment for pulmonary tuberculosis. Am J Respir Crit Care Med. Aug 1 2006;174(3):331-8. [Medline].
Asensio JA, Arbues A, Perez E, et al. Live tuberculosis vaccines based on phoP mutants: a step towards clinical trials. Expert Opin Biol Ther. Feb 2008;8(2):201-11. [Medline].
Centers for Disease Control and Prevention. Trends in tuberculosis--United States, 2007. MMWR Morb Mortal Wkly Rep. Mar 21 2008;57(11):281-5. [Medline].
World Health Organization. Antituberculosis drug resistance in the world. The WHO/IUATLD global project on anti-tuberculosis drug resistance surveillance WHO. Geneva. 2008;1-120. [Full Text].
Mlambo CK, Warren RM, Poswa X, et al. Genotypic diversity of extensively drug-resistant tuberculosis (XDR-TB) in South Africa. Int J Tuberc Lung Dis. Jan 2008;12(1):99-104. [Medline].
Leung CC, Lam TH, Chan WM, et al. Lower risk of tuberculosis in obesity. Arch Intern Med. Jun 25 2007;167(12):1297-304. [Medline].
Brown M, Varia H, Bassett P, et al. Prospective study of sputum induction, gastric washing, and bronchoalveolar lavage for the diagnosis of pulmonary tuberculosis in patients who are unable to expectorate. Clin Infect Dis. Jun 1 2007;44(11):1415-20. [Medline].
Schuurmans MM, Ellmann A, Bouma H, et al. Solitary pulmonary nodule evaluation with 99mTc-methoxy isobutyl isonitrile in a tuberculosis-endemic area. Eur Respir J. Dec 2007;30(6):1090-5. [Medline].
Mazurek GH, Jereb J, Lobue P, Iademarco MF, Metchock B, Vernon A. Guidelines for using the QuantiFERON-TB Gold test for detecting Mycobacterium tuberculosis infection, United States. MMWR Recomm Rep. Dec 16 2005;54:49-55. [Medline].
Manuel O, Humar A, Preiksaitis J, et al. Comparison of quantiferon-TB gold with tuberculin skin test for detecting latent tuberculosis infection prior to liver transplantation. Am J Transplant. Dec 2007;7(12):2797-801. [Medline].
Mazurek GH, Weis SE, Moonan PK, et al. Prospective comparison of the tuberculin skin test and 2 whole-blood interferon-gamma release assays in persons with suspected tuberculosis. Clin Infect Dis. Oct 1 2007;45(7):837-45. [Medline].
[Best Evidence] Jafari C, Thijsen S, Sotgiu G, Goletti D, Benítez JA, Losi M, et al. Bronchoalveolar lavage enzyme-linked immunospot for a rapid diagnosis of tuberculosis: a Tuberculosis Network European Trialsgroup study. Am J Respir Crit Care Med. Oct 1 2009;180(7):666-73. [Medline].
[Best Evidence] Diacon AH, Pym A, Grobusch M, Patientia R, Rustomjee R, Page-Shipp L, et al. The diarylquinoline TMC207 for multidrug-resistant tuberculosis. N Engl J Med. Jun 4 2009;360(23):2397-405. [Medline].
Slama K, Chiang CY, Enarson DA, et al. Tobacco and tuberculosis: a qualitative systematic review and meta-analysis. Int J Tuberc Lung Dis. Oct 2007;11(10):1049-61. [Medline].
Menzies D, Joshi R, Pai M. Risk of tuberculosis infection and disease associated with work in health care settings. Int J Tuberc Lung Dis. Jun 2007;11(6):593-605. [Medline].
Weir RE, Gorak-Stolinska P, Floyd S, et al. Persistence of the immune response induced by BCG vaccination. BMC Infect Dis. Jan 25 2008;8:9. [Medline].
Cox HS, Morrow M, Deutschmann PW. Long term efficacy of DOTS regimens for tuberculosis: systematic review. BMJ. Mar 1 2008;336(7642):484-7. [Medline].
Jasmer RM, Bozeman L, Schwartzman K, et al. Recurrent tuberculosis in the United States and Canada: relapse or reinfection?. Am J Respir Crit Care Med. Dec 15 2004;170(12):1360-6. [Medline].
van Rie A, Warren R, Richardson M, et al. Exogenous reinfection as a cause of recurrent tuberculosis after curative treatment. N Engl J Med. Oct 14 1999;341(16):1174-9. [Medline].
Sonnenberg P, Glynn JR, Fielding K, et al. How soon after infection with HIV does the risk of tuberculosis start to increase? A retrospective cohort study in South African gold miners. J Infect Dis. Jan 15 2005;191(2):150-8. [Medline].
Muga R, Ferreros I, Langohr K, et al. Changes in the incidence of tuberculosis in a cohort of HIV-seroconverters before and after the introduction of HAART. AIDS. Nov 30 2007;21(18):2521-7. [Medline].
Centers for Disease Control and Prevention. Managing Drug Interactions in the Treatment of HIV-Related Tuberculosis. CDC. Available at http://www.cdc.gov/tb/TB_HIV_Drugs/default.htm. Accessed 08/20/2008.
Keane J, Gershon S, Wise RP, et al. Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent. N Engl J Med. Oct 11 2001;345(15):1098-104. [Medline].
American Thoracic Society, Centers for Disease Control and Prevention. Targeted tuberculin testing and treatment of latent tuberculosis infection. American Thoracic Society. MMWR Morb Mortal Wkly Rep. Jun 9 2000;49(RR-6):1-51. [Medline].
Blumberg HM, Burman WJ, Chaisson RE, et al. American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. Am J Respir Crit Care Med. Feb 15 2003;167(4):603-62. [Medline].
Busillo CP, Lessnau KD, Sanjana V, et al. Multidrug resistant Mycobacterium tuberculosis in patients with human immunodeficiency virus infection. Chest. Sep 1992;102(3):797-801. [Medline].
Centers for Disease Control and Prevention. Emergence of Mycobacterium tuberculosis with extensive resistance to second-line drugs--worldwide, 2000-2004. MMWR Morb Mortal Wkly Rep. Mar 24 2006;55(11):301-5. [Medline].
[Guideline] Centers for Disease Control and Prevention. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR-Recomm Rep. Dec 30 2005;54(17):1-141.
Frieden TR, Sterling T, Pablos-Mendez A, et al. The emergence of drug-resistant tuberculosis in New York City. New Engl J Med. 1993;328:521-526. [Medline].
Friedman LN, ed. Boca Raton, Fla. In: Tuberculosis: Current Concepts and Treatment. CRC Press; 1994:1-366.
Havlir DV, Barnes PF. Tuberculosis in patients with human immunodeficiency virus infection. N Engl J Med. Feb 4 1999;340(5):367-73. [Medline].
Jacobs RF. Multiple-drug-resistant tuberculosis. Clin Infect Dis. Jul 1994;19(1):1-8; quiz 9-10. [Medline].
Jasmer RM, Nahid P, Hopewell PC. Clinical practice. Latent tuberculosis infection. N Engl J Med. Dec 5 2002;347(23):1860-6. [Medline].
Khan A, Sterling TR, Reves R, et al. Lack of weight gain and relapse risk in a large tuberculosis treatment trial. Am J Respir Crit Care Med. Aug 1 2006;174(3):344-8. [Medline].
Khan K, Muennig P, Behta M, et al. Global drug-resistance patterns and the management of latent tuberculosis infection in immigrants to the United States. N Engl J Med. Dec 5 2002;347(23):1850-9. [Medline].
Kim HJ, Lee HJ, Kwon SY, et al. The prevalence of pulmonary parenchymal tuberculosis in patients with tuberculous pleuritis. Chest. May 2006;129(5):1253-8. [Medline].
Larsen NM, Biddle CL, Sotir MJ, et al. Risk of tuberculin skin test conversion among health care workers: occupational versus community exposure and infection. Clin Infect Dis. Oct 1 2002;35(7):796-801. [Medline].
Pomerantz M, Brown JM. Surgery in the treatment of multidrug-resistant tuberculosis. Clin Chest Med. Mar 1997;18(1):123-30. [Medline].
Rao VK, Iademarco EP, Fraser VJ, et al. Delays in the suspicion and treatment of tuberculosis among hospitalized patients. Ann Intern Med. Mar 2 1999;130(5):404-11. [Medline].
Further Reading
Keywords
tuberculosis, TB, Mycobacterium tuberculosis, M tuberculosis, multidrug-resistant tuberculosis, MDR-TB, extensively drug-resistant tuberculosis, XDR-TB, pulmonary TB, pulmonary tuberculosis, tuberculous meningitis, skeletal TB, skeletal tuberculosis, genitourinary TB, genitourinary tuberculosis, gastrointestinal TB, gastrointestinal tuberculosis, tuberculous lymphadenitis, scrofula, cutaneous TB, cutaneous tuberculosis, chorioretinitis, brain tuberculosis, Pott disease
