Clinical Review

Current medical treatment for tuberculosis

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7375.1282 (Published 30 November 2002) Cite this as: BMJ 2002;325:1282
  1. Edward D Chan, assistant professor of medicine (chane@njc.org),
  2. Michael D Iseman, professor of medicine
  1. Department of Medicine, National Jewish Medical and Research Center, Denver, CO 80206, USA
  1. Correspondence to: E D Chan K613E, National Jewish Medical and Research Center, 1400 Jackson St, Denver, CO 80206, USA
  • Accepted 13 September 2002

Instigating effective treatment regimens in a way that improves patient adherence is vital to tackling the global resurgence of tuberculosis

About one third of the world's population has latent tuberculosis, caused by Mycobacterium tuberculosis infection.1 From this pool, roughly 9 million cases of active tuberculosis emerge annually, resulting in 2-3 million deaths. Most new cases occur in the most populated nations—India and China—but the highest rates of disease are seen in sub-Saharan Africa, the Indonesian and Philippine archipelagos, Afghanistan, Bolivia, and Peru. In these regions case rates typically exceed 300 cases per 100 000 per year. 1 2 Although the incidence of tuberculosis declined in North America and western Europe throughout most of the latter half of the 20th century, case rates have increased over the past 10 years mainly because of immigration, HIV/AIDS, and the neglect of tuberculosis control programmes. 3 4 One vital factor in curbing the increase of tuberculosis is the instigation of proper treatment that not only encompasses an effective regimen but also ensures compliance with and response to treatment. This review highlights current treatment recommendations for tuberculosis.

Summary points

Many people worldwide have latent or active tuberculosis, and the number of active cases is expected to increase in the future

The most common cause of treatment failure and acquired drug resistance is non-adherence; predicting non-adherence is highly problematic

Directly observed therapy is the most effective means of combatting non-adherence; intermittent (less than daily) regimens facilitate the therapy

Testing the susceptibility of Mycobacterium tuberculosis to drugs is essential for identifying resistance and tailoring treatment

Managing multidrug resistant tuberculosis is complex and should, when possible, be done in specialised programmes

Sources and selection criteria

We performed a Medline search of the past 10 years using the key words “tuberculosis and treatment or drug therapy” to find pertinent literature. We also searched bibliographies …

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