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Actualización sobre el tratamiento de la tuberculosis y la infección latente por tuberculosis
Henry M Blumberg1, Michael K Leonard, Robert M Jasmer
1Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Ga 30303, USA. henry.m.blumberg@emory.edu
JAMA
|June 9, 2005
Resumen
La tuberculosis (TB) es un problema de salud mundial. El tratamiento consiste en un régimen de 4 medicamentos durante 6-9 meses, con terapia de observación directa recomendada para mejorar los resultados y prevenir la resistencia a los medicamentos.
Área de la Ciencia:
- Salud Pública La salud pública.
- Enfermedades infecciosas Enfermedades infecciosas.
- Microbiología Microbiología.
Sus antecedentes:
- La tuberculosis (TB) sigue siendo una preocupación significativa para la salud pública mundial, particularmente en áreas urbanas y poblaciones específicas de pacientes dentro de los Estados Unidos.
- Si bien los casos de tuberculosis han disminuido desde 1992, los desafíos actuales requieren estrategias de control sólidas.
- La gestión de la finalización del tratamiento de la tuberculosis y la prevención de la resistencia a los medicamentos son responsabilidades críticas de salud pública.
Objetivo del estudio:
- Para esbozar las directrices actuales de tratamiento de la tuberculosis y enfatizar la importancia de la adhesión.
- Para resaltar el papel de la terapia observada directamente (DOT) en la mejora de la finalización del tratamiento y la prevención de la resistencia a los medicamentos.
- Discutir el enfoque renovado en el tratamiento de la infección latente de tuberculosis (LTBI) como una estrategia clave de eliminación de la tuberculosis.
Principales métodos:
- Los regímenes estándar de múltiples medicamentos para la TB activa, por lo general son la isoniazida, la rifampicina, la pirazinamida y el etambutol.
- La terapia de observación directa (DOT) como una intervención recomendada para todos los pacientes diagnosticados con TB.
- Protocolos de detección y tratamiento para la infección latente de TB (LTBI), centrados en poblaciones de alto riesgo.
Principales resultados:
- Los regímenes basados en rifampicina para la TB susceptible a medicamentos requieren un mínimo de 6 a 9 meses de tratamiento.
- El DOT se asocia con mayores tasas de finalización del tratamiento y un menor riesgo de TB resistente a los medicamentos.
- La isoniazida durante 9 meses es el régimen preferido para el tratamiento de la infección latente de TB.
Conclusiones:
- El control efectivo de la tuberculosis requiere el cumplimiento de los regímenes y estrategias prescritas como DOT.
- El tratamiento dirigido de la infección latente de TB es crucial para eliminar el reservorio de TB.
- Existe una necesidad continua y urgente de desarrollar nuevos medicamentos contra la tuberculosis.
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