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Treatment of Isoniazid-Resistant Pulmonary Tuberculosis

Tuberculosis (TB) remains a threat to public health and is the leading cause of death globally. Isoniazid (INH) is an important first-line agent for the treatment of TB considering its early bactericidal activity. Resistance to INH is now the most common type of resistance. Resistance to INH reduces...

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Autores principales: Jhun, Byung Woo, Koh, Won-Jung
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Academy of Tuberculosis and Respiratory Diseases 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6953491/
https://www.ncbi.nlm.nih.gov/pubmed/31905429
http://dx.doi.org/10.4046/trd.2019.0065
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author Jhun, Byung Woo
Koh, Won-Jung
author_facet Jhun, Byung Woo
Koh, Won-Jung
author_sort Jhun, Byung Woo
collection PubMed
description Tuberculosis (TB) remains a threat to public health and is the leading cause of death globally. Isoniazid (INH) is an important first-line agent for the treatment of TB considering its early bactericidal activity. Resistance to INH is now the most common type of resistance. Resistance to INH reduces the probability of treatment success and increases the risk of acquiring resistance to other first-line drugs such as rifampicin (RIF), thereby increasing the risk of multidrug-resistant-TB. Studies in the 1970s and 1980s showed high success rates for INH-resistant TB cases receiving regimens comprised of first-line drugs. However, recent data have indicated that INH-resistant TB patients treated with only first-line drugs have poor outcomes. Fortunately, based on recent systematic meta-analyses, the World Health Organization published consolidated guidelines on drug-resistant TB in 2019. Their key recommendations are treatment with RIF-ethambutol (EMB)-pyrazinamide (PZA)-levofloxacin (LFX) for 6 months and no addition of injectable agents to the treatment regimen. The guidelines also emphasize the importance of excluding resistance to RIF before starting RIF-EMB-PZA-LFX regimen. Additionally, when the diagnosis of INH-resistant TB is confirmed long after starting the first-line TB treatment, the clinician must decide whether to start a 6-month course of RIF-EMB-PZA-LFX based on the patient's condition. However, these recommendations are based on observational studies, not randomized controlled trials, and are thus conditional and based on low certainty of the effect estimates. Therefore, further work is needed to optimize the treatment of INH-resistant TB.
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spelling pubmed-69534912020-01-21 Treatment of Isoniazid-Resistant Pulmonary Tuberculosis Jhun, Byung Woo Koh, Won-Jung Tuberc Respir Dis (Seoul) Review Article Tuberculosis (TB) remains a threat to public health and is the leading cause of death globally. Isoniazid (INH) is an important first-line agent for the treatment of TB considering its early bactericidal activity. Resistance to INH is now the most common type of resistance. Resistance to INH reduces the probability of treatment success and increases the risk of acquiring resistance to other first-line drugs such as rifampicin (RIF), thereby increasing the risk of multidrug-resistant-TB. Studies in the 1970s and 1980s showed high success rates for INH-resistant TB cases receiving regimens comprised of first-line drugs. However, recent data have indicated that INH-resistant TB patients treated with only first-line drugs have poor outcomes. Fortunately, based on recent systematic meta-analyses, the World Health Organization published consolidated guidelines on drug-resistant TB in 2019. Their key recommendations are treatment with RIF-ethambutol (EMB)-pyrazinamide (PZA)-levofloxacin (LFX) for 6 months and no addition of injectable agents to the treatment regimen. The guidelines also emphasize the importance of excluding resistance to RIF before starting RIF-EMB-PZA-LFX regimen. Additionally, when the diagnosis of INH-resistant TB is confirmed long after starting the first-line TB treatment, the clinician must decide whether to start a 6-month course of RIF-EMB-PZA-LFX based on the patient's condition. However, these recommendations are based on observational studies, not randomized controlled trials, and are thus conditional and based on low certainty of the effect estimates. Therefore, further work is needed to optimize the treatment of INH-resistant TB. The Korean Academy of Tuberculosis and Respiratory Diseases 2020-01 2019-11-07 /pmc/articles/PMC6953491/ /pubmed/31905429 http://dx.doi.org/10.4046/trd.2019.0065 Text en Copyright©2020. The Korean Academy of Tuberculosis and Respiratory Diseases http://creativecommons.org/licenses/by-nc/4.0/ It is identical to the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/)
spellingShingle Review Article
Jhun, Byung Woo
Koh, Won-Jung
Treatment of Isoniazid-Resistant Pulmonary Tuberculosis
title Treatment of Isoniazid-Resistant Pulmonary Tuberculosis
title_full Treatment of Isoniazid-Resistant Pulmonary Tuberculosis
title_fullStr Treatment of Isoniazid-Resistant Pulmonary Tuberculosis
title_full_unstemmed Treatment of Isoniazid-Resistant Pulmonary Tuberculosis
title_short Treatment of Isoniazid-Resistant Pulmonary Tuberculosis
title_sort treatment of isoniazid-resistant pulmonary tuberculosis
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6953491/
https://www.ncbi.nlm.nih.gov/pubmed/31905429
http://dx.doi.org/10.4046/trd.2019.0065
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