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Interventions for Tuberculosis Control and Elimination

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Interventions for Tuberculosis Control and Elimination Interventions for Tuberculosis Control and Elimination 2002 Tuberculosis Interventions International Union Against Tuberculosis and Lung Disease Interventions for Tuberculosis Control and Elimination 2002 Hans L Rieder International Union Against Tuberculosis and Lung Disease 68, boulevard Saint Michel, 75006 Paris, France The publication of this guide was made possible thanks to the support of the United States Centers for Disease Control and Prevention, the British Columbia Lung Association, the French Ministry of Foreign Affairs, and the Norwegian Royal Ministry of Foreign Affairs. Editor International Union Against Tuberculosis and Lung Disease (IUATLD), 68 boulevard Saint Michel, 75006 Paris, France Author : H. L. Rieder © International Union Against Tuberculosis and Lung Disease (IUATLD) March 2002 All rights reserved No part of this publication may be reproduced without the prior permis- sion of the authors, and the publisher. ISBN : 2-914365-11-X II Table of contents Acknowledgments. 1 Preface. 3 Introduction . 5 Summary – the role of specific interventions . 9 1. Chemotherapy . 15 Essential drugs . 15 Isoniazid. 17 Rifampicin . 26 Pyrazinamide . 35 Ethambutol . 37 Streptomycin . 41 Thioacetazone . 45 Fixed-dose combinations . 49 Principal prerequisites for an efficacious anti-tuberculosis drug. 50 Early bactericidal activity . 51 Sterilizing activity. 52 Ability to prevent emergence of resistance to the companion drug . 53 Emergence of anti-tuberculosis drug resistance . 54 Effective or functional monotherapy . 55 Monotherapy during sterilization of special populations . 56 Differences in bactericidal activity . 57 Sub-inhibitory concentrations . 57 Differences in post-antibiotic effect (lag phase) . 59 Clinical trials in the treatment of pulmonary tuberculosis . 59 Streptomycin monotherapy . 61 Streptomycin plus para-aminosalicylic acid . 61 Streptomycin plus para-aminosalicylic acid plus isoniazid. 62 Isoniazid plus ethambutol . 64 Isoniazid plus thioacetazone . 65 Isoniazid plus rifampicin . 66 III Isoniazid plus rifampicin plus pyrazinamide (plus a fourth drug) . 66 Rifampicin-containing continuation phase . 67 Non-rifampicin-containing continuation phase . 68 Intermittent regimens . 68 Treatment regimens of less than six months’ duration . 70 Clinical trials in extrapulmonary tuberculosis . 71 Tuberculosis of peripheral lymph nodes . 71 Tuberculosis of the spine . 72 Tuberculosis of the central nervous system . 73 Influence of HIV infection on the choice of a regimen. 74 Adverse drug events . 74 Treatment efficacy . 75 Influence of isoniazid resistance on the choice of a regimen . 77 Influence of isoniazid plus rifampicin resistance on the choice of a regimen . 78 Strategic considerations, indications, and recommendations for the choice of treatment regimens in a national tuberculosis control program . 78 Choice of first-line regimen. 79 8-month regimens. 80 6-month regimens. 80 12-month regimens . 81 Choice of re-treatment regimen . 81 Treatment of patients with organisms resistant to isoniazid and rifampicin . 82 Case holding. 84 Directly observed treatment. 84 Can emergence of drug resistance be outpaced in a national tuberculosis program? . 84 The approach to management of adverse drug events . 86 The patient with hepatitis . 87 The patient with gastrointestinal symptoms . 88 The patient with impaired vision . 88 The patient with vestibulo-cochlear toxicity . 89 The patient with neurologic symptoms. 89 The patient with hypersensitivity reactions or muco-cutaneous signs and symptoms of toxicity. 89 The patient with hematologic abnormalities. 90 The patient with acute renal toxicity . 91 The patient with osteo-articular pain . 91 The approach to the patient with pre-existing medical conditions . 91 The patient with liver injury . 91 The patient with renal failure . 92 IV The patient with impaired hearing or impaired balance . 92 The patient with impaired vision . 92 The patient with gastrointestinal malabsorption . 92 The pregnant patient . 93 2. Prophylactic treatment . 95 Rationale and experiences with prophylactic treatment . 95 Indications and recommendations for the use of prophylactic treatment . 96 3. Vaccination . 97 Early vaccine development. 97 Vaccination with Mycobacterium bovis . 97 Vaccination with Mycobacterium chelonae . 97 Vaccination with BCG . 98 Vaccine development . 98 The BCG strain family. 101 Safety record of BCG vaccination . 101 Management of adverse reactions due to BCG vaccination . 104 Efficacy and effectiveness of BCG vaccination . 104 Prospective and retrospective studies on BCG vaccination . 107 Protection conferred by BCG vaccination against disseminated and meningeal tuberculosis, and against death from tuberculosis. 108 Protection conferred by BCG vaccination of newborns and infants . 109 Protection conferred by BCG vaccination of children over one year of age . 111 Protection conferred by BCG vaccination among adolescents and adults . 112 Protection conferred by BCG vaccination across various age groups . 114 Hypotheses about the variation in the efficacy of BCG vaccination . 115 Differences in methodological stringency . 116 Differences in vaccine strains . 117 Differences in vaccine dose . 117 Differences in virulence of M. tuberculosis strains . 117 Differences in risk attributable to exogenous re-infection tuberculosis. 118 Differences in genetic make-up of vaccinees. 118 Differences in nutritional status of vaccinees . 118 Differences in prevalence of infection with environmental mycobacteria . 119 Other factors . 121 BCG revaccination . 123 Effects of BCG other than those directed against tuberculosis . 123 Indications and recommendations for the use of BCG vaccination. 123 V 4. Preventive chemotherapy . 127 Prevention of disease in tuberculin skin test reactors . 128 Prevention of disease in persons with risk factors . 130 Recently acquired infection . 130 Infection with the human immunodeficiency virus . 131 Spontaneously healed tuberculosis with fibrotic residuals . 134 Silicosis . 135 Renal failure . 135 Prevention of disease following cessation of preventive chemotherapy . 136 Prevention of disease with different durations of treatment . 136 Prevention of disease with alternatives to isoniazid . ..
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