Challenges of antituberculosis treatment in patients with difficult clinical conditions

Tuberculosis (TB) is an infectious disease with a global distribution. The mainstay of treatment is a combination of antituberculous (AT) drugs. The standard combination uses four first-line AT drugs; however, in certain groups of patients, the combination must be modified or reduced in dosage. This is especially true of patients with comorbidities, in the elderly and in pregnant women. The aim of this review is to provide up-to-date information regarding AT treatment in a variety of special patient populations.

The recommendations presented here are based on the clinical experience of the author, as well as data presented in textbooks, World Health Organization national and international guidelines, various respiratory societies and original articles quoted in medical databases. The time frame for this review was from 1995 to 2013. The data search was carried out only in English and the index words were as follows: tuberculosis - treatment - liver disease - kidney disease - HIV infection - skin toxicity - elderly - pregnancy.

Based on our experience and the described sources above, we present AT treatment recommendations for specific patient populations.

TB can be difficult to diagnose and treat. This can be especially true in patients with comorbidities, adverse reactions to AT drugs, the elderly and pregnant women. Despite the difficulties, an early diagnosis followed immediately by AT treatment should be the norm for these patients. When choosing a suitable AT regimen, we must consider the potential side effects of the drugs, which could exacerbate an underlying comorbidity, harm an expectant mother or fetus, or adversely affect the elderly.