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The Treatment of Tuberculosis

The incidence of tuberculosis is increasing in the United States. Although the lung is still the most common site of infection, extrapulmonary disease is becoming more prevalent, particularly in patients infected with human immunodeficiency virus (HIV). Clinically active tuberculosis is treated with a combination of drugs. Recommended therapy consists of a six-month regimen of isoniazid and rifampin, with pyrazinamide given for the first two months. Longer regimens are used in patients infected with HIV. Monthly monitoring for adverse effects and treatment response is necessary. Compliance is the most important factor for successful treatment. Treatment failure usually requires the use of more toxic second-line drugs. In such cases, drug susceptibility studies may be useful.