[Tuberculosis treatment in adults]

The quadritherapy by isoniazid, rifampicin, pyrazinamide and ethambutol, is still the gold standard for the treatment of tuberculosis disease. Except for severe presentations, the treatment remains based on a 6 months therapy with a 2 months induction phase. During the first health care contact, looking for an immunosupression and risk factors of hepatotoxicity and multiresistant strains is necessary. A close supervision by medical staff is recommended during all treatment duration. Rifampicin expose to drug interactions. In France, once the diagnosis is made, the referent practitioner and the biologist must notify the case to the local Health Authorities which is in charge of finding and treat, if needed, the newly infected case contacts. In order to prevent transmission, a respiratory isolation must be performed for smear positive patients. In case of renal or hepatic previous impairment, a multidisciplinary and closely supervision is recommended. Treatment of extensively and multi drug resistant (MDR) tuberculosis is based on combination of 2nd line drugs, and a prolonged treatment is advised. Expert supervision is necessary for case management.