Treatment of active tuberculosis
(NEJM 2015;373:2149; Lancet 2016;387:1211)
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Prior to treatment, consult ID, check LFTs, Cr, HIV & hepatitis A/B/C screen, DM screen, pregnancy screen, vision testing for acuity and color, EtOH use history
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Treatment requires several drugs to prevent resistance (see below)
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Suspect MDR TB if prior TB Rx (esp. if poor adherence), travel to area w/ ↑ rates of MDR (India, China, Eastern Europe including Russia, South Africa), exposure to person w/ likely MDR-TB (NEJM 2008;359:636)
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“Paradoxical worsening” of sx can occur after starting Rx. More common w/ extrapulm. TB & more frequent/severe w/ concurrent immune reconstitution (eg, HIV ⊕ Pts started on ART, Pts taken off immunosuppression). Must r/o Rx failure (repeat Cx, imaging), consider checking drug levels.
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Duration of treatment varies based on host, clinical manifestation, and improvement/ progression on treatment