Treatment of pulmonary tuberculosis

Sang-Won Yoon; Jae Chol Choi

doi:10.5124/jkma.2019.62.1.25

J Korean Med Assoc > Volume 62(1); 2019 > Article

Yoon and Choi: Treatment of pulmonary tuberculosis

Focused Issue of This Month

Treatment and prevention of pulmonary tuberculosis

Journal of the Korean Medical Association 2019; 62(1): 25-36.

Published online: January 21, 2019

DOI: http://dx.doi.org/10.5124/jkma.2019.62.1.25

Treatment of pulmonary tuberculosis

Sang-Won Yoon, MD

, Jae Chol Choi, MD

Division of Pulmonary Medicine, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.

Corresponding author: Jae Chol Choi. medics27@cau.ac.kr

Received December 20, 2018 Accepted January 08, 2019

Korean Medical Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Tuberculosis (TB) remains the world's leading cause of death from a single infectious disease. In addition, the incidence of TB is high in South Korea. Effective TB control requires early diagnosis and initiation of appropriate treatment. Therefore, it is very important for clinicians to understand evidence-based practical recommendations and to be familiar with up-to-date treatment regimens. In this review, we first describe anti-TB drugs, including new drugs. Secondly, we discuss the treatment of drug-susceptible TB. Finally, we present treatment strategies for drug-resistant TB, which is divided into isoniazid-resistant TB, rifampin-resistant TB, and multi-drug resistant TB. For the treatment of drug-susceptible TB, we recommend 2 months of 4 drugs (isoniazid, rifampin, ethambutol, and pyrazinamide) followed by 4 months of 2 drugs (isoniazid and rifampin). For the treatment of isoniazid-resistant TB, we recommend 6 to 9 months of 4 drugs (rifampin, ethambutol, pyrazinamide, and levofloxacin or moxifloxacin). For the treatment of multi-drug resistant TB (MDR-TB), we recommend a minimum of 5 secondary drugs, including an injectable agent and quinolone. Although the World Health Organization recommended a shorter MDR-TB regimen in 2016, the Korean guidelines for tuberculosis have not yet accepted the shorter regimen. The treatment regimen of TB differs depending on the drug resistance pattern. Therefore, it is important to treat TB properly after confirming the drug resistance pattern. In addition, as new drugs are developed, new treatment guidelines for MDR-TB should be developed that are appropriate for circumstances in Korea.

Tuberculosis; Therapeutics; Guideline; Tuberculosis, multidrug-resistant; World Health Organization

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Table 1

Classification of anti-tuberculosis drug

Adapted from World Health Organization. WHO treatment guidelines for isoniazid-resistant tuberculosis: supplement to the WHO treatment guidelines for drug-resistant tuberculosis [Internet]. Geneva: World Health Organization; 2018 [8].

Table 2

Medicines recommended for the treatment of rifampin resistant tuberculosis and multi-drug resistant tuberculosis in 2016

Adapted from World Health Organization. WHO treatment guidelines for drug-resistant tuberculosis: 2016 update [Internet]. Geneva: World Health Organization; 2016 [6].

Table 3

Medicines recommended for the treatment of rifampin resistant tuberculosis and multi-drug resistant tuberculosis in late 2018

Adapted from World Health Organization. Rapid communication: key changes to treatment of multidrug- and rifampicin-resistant tuberculosis (MDR/RR-TB) [Internet]. Geneva: World Health Organization; 2018 [10].