Current Treatment Options in Tuberculosis

Abstract

Tuberculosis (TB) is a leading cause of morbidity and ranks among the ten most common causes of death worldwide. Due to the wide range of clinical pictures TB can cause, diagnosis is often difficult and, especially in low-incidence countries, is sometimes underestimated. Therefore, it is important to consider the diagnosis of TB, especially in immunocompromised patients, and contact TB experts if diagnosis is unclear. Since the emergence of resistant strains is increasing, it is important to test resistance once TB is diagnosed. A drug-susceptible TB is treated with a standard 6-month chemotherapy regimen using a combination of four drugs (isoniazid, rifampicin, ethambutol, and pyrazinamide for 2 months followed by rifampicin and isoniazid for 4 months) according to the current guidelines. With this treatment, cure rates of approximately 90 % can be achieved. Because of adverse effects, drug–drug interactions, and sometimes reduced compliance towards treatment, regular clinical and laboratory monitoring of patients under TB treatment is required. Drug-resistant TB should only be treated by experienced infectious disease specialists. In patients with a positive interferon-γ release assay or tuberculin skin test without clinical signs of active disease, latent TB should be considered and the need for chemoprevention has to be evaluated. Fortunately, promising new drugs are currently in the development pipeline that, after careful evaluation in clinical studies, may lead to shortened treatment regimens in the future. BCG (Bacillus Calmette–Guerin) vaccine is still the only available vaccine with a >50 % efficacy for protection against progression from infection to active disease. New vaccines are currently under investigation.