TB Treatment and Complications

The aims of TB drug treatment are to rapidly reduce bacillary load to achieve clinical improvement, to remove persistor organisms to prevent relapse, and to avoid drug resistance. Standard first-line treatment for drug sensitive PTB and EPTB disease in both HIV-positive and -negative adults requires quadruple therapy with RIF, INH, PZA and ETH. Drug therapy is typically provided for 6-months (2 RHZE/4 RH) with extension of the continuation phase in the treatment of TB meningitis, ocular TB disease, and possibly in those with a high initial bacillary load. Adjunctive treatments including pyridoxine (all patients), and corticosteroids (TB meningitis) may be required. Drugs can be provided individually or in fixed-dose preparations, but practitioners must be aware of common/severe side effects of these medications. Treatment programmes must have capacity for pre-treatment assessment of patient risk, monitoring of patients during treatment, and management of complications.