Treatment of tuberculosis

Tuberculosis is still one of the main infectious diseases affecting mankind and is poorly controlled, despite the availability of cheap and effective drugs for the past 40-50 years. There are three basic principles of treatment against tuberculosis defined by the WHO and International Union Against Tuberculosis and Lung Disease (IUATLD). First is the use of potent bactericidal drugs in combination, to render the patients noninfective as rapidly as possible and prevent the transmission to other patients. Second, prolonged treatment eradicates even the dormant bacteria and prevents relapse. Third, regular treatment with correct doses is given in order to prevent the development of drug resistance. Most cases of tuberculosis can still be cured by a correct combination of isoniazid, rifampicin, pyrazinamide and ethambutol administered for 2 months, followed by isoniazid and rifampicin for 4 months. Antituberculous drugs are associated with adverse events, particularly in patients with comorbidities such as HIV. The main problems in the management of tuberculosis are the frequent association with HIV, particularly in Africa, and the increasing number of drug-resistant cases, particularly in Eastern Europe and Asia, making currently available treatment schedules inefficient. New drugs are urgently needed to cure these cases. This paper presents the basis for the current treatment schedules proposed by international organizations (WHO and IUATLD) for different forms of tuberculosis, the management of special situations and drug-resistant cases and of adverse events. This review is intended primarily for physicians unfamiliar with the management of tuberculosis.