Chapter 5: Treatment of tuberculosis disease

Abstract

KEY POINTS • Treatment of drug-susceptible tuberculosis (TB) disease should include 2 effective drugs at all times, and at least 3 effective drugs in the intensive phase (ie, first 2 months of therapy). • Most patients with TB disease should be initiated on a regimen of isoniazid, rifampin, pyrazinamide and ethambutol until results of genotypic or phenotypic drug susceptibility are available. Therapy should be given daily for the first 2 months, then daily when feasible. • Meaningful and culturally appropriate patient engagement, education and support are critical for achieving successful TB treatment. • TB clinicians and programs should provide comprehensive, patient-centred care that uses incentives and enablers to ensure optimal treatment adherence. • All jurisdictions should have capacity to provide daily, in-person, supportive care for people with TB. Support should be tailored to individual needs and may include directly observed therapy. • Regardless of insurance coverage or immigration documentation, people with active TB should be provided with TB medications and appropriate treatment support free of charge. • People at high risk for TB recurrence should be monitored for signs/symptoms of TB recurrence during the first 12-24 months post-therapy. • Pulmonary function testing should be performed in all people completing therapy for pulmonary TB, given the high incidence of respiratory disease in people with TB. • TB programs should ensure that people with TB are linked to a stable primary care provider before the end of TB treatment.