Revised Recommendations for the Treatment of Tuberculosis Disease

Revised national recommendations These guidelines, which replace Following are some highlights of the for the treatment of tuberculosis (TB) previous recommendations published new guidelines: disease were recently issued by the in 1994, were developed to address Centers for Disease Control and current issues such as the availability 1. The responsibility for successPrevention (CDC), the Infectious of new antituberculosis drugs and ful completion of an appropriate Diseases Society of America (IDSA), recent research findings on treatment TB treatment regimen is clearly and the American Thoracic Society regimens. The new recommendaassigned to the private clinician (ATS). This is the first time IDSA has tions provide updated information and public health department, co-authored a TB treatment stateand guidance on several issues of rather than to the patient. ment with ATS and CDC. The particular interest to clinicians who guidelines, “Treatment of Tuberculocare for TB patients in Minnesota. This is a significant philosophic sis,” were published in the American These issues include drug-resistant departure from previous guideJournal of Respiratory and Critical TB and extrapulmonary disease lines. Successful treatment of TB Care Medicine (2003;167:603-662) both of which occur most frequently benefits both the individual patient and reprinted in Morbidity and among foreign-born TB patients, who and the larger community by Mortality Weekly Report (MMWR comprise approximately 80% of TB rapidly rendering the patient 2003;52[No. RR-11]:1-80). cases statewide. noninfectious and thereby preventing both ongoing transmisTable 1. Possible Components of a Multifaceted, Patient-Centered sion and the emergence of drugTreatment Strategy for Tuberculosis (TB) Disease resistant strains of TB. A public health department or private Enablers: interventions to assist the patient in completing therapy clinician who provides treatment • Transportation vouchers for a TB patient is assuming a • Child care public health function that • Convenient clinic hours and locations includes not only prescribing an • Clinic personnel who speak the language(s) of the population(s) served appropriate regimen, but also • Reminder systems and follow-up on missed appointments ensuring the patient’s adherence • Social service assistance (e.g., referrals for substance abuse treatment to the regimen until treatment is and counseling, housing assistance) completed. • Outreach workers (bilingual/bicultural, as needed), who may provide continued.... services related to facilitating the patient’s adherence, including directly observed therapy, follow-up on missed appointments, monthly monitoring, transportation, sputum collection, social service assistance, or educational reinforcement • Integrating TB care with care for other medical conditions