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Current Options in Treatment and Issues in Tuberculosis Care in Low- and Middle-Income Countries

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Handbook of Global Tuberculosis Control

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Abstract

The successful treatment of tuberculosis (TB) requires long-term administration of multiple antibiotics. In patients whose TB is caused by drug-sensitive strains, modern regimens provide rapid reduction of contagiousness and relief of symptoms as well as reduction in risk of death and disability. The most effective regimen requires four drugs for the initial 2 months, followed by 4 additional months of treatment with the two most effective anti-TB drugs, Isoniazid and Rifampin. In multiple randomized control trials, this regimen was highly effective in treating drug sensitive TB and had low rates of treatment failure, relapse, and acquired drug resistance.

Drug resistant TB (DR-TB) has emerged in almost all settings where TB has been treated. Prevalence of DR-TB is much higher where TB regimens are inadequate, or there is poor follow-up, or poor drug quality. Treatment of DR-TB is much more difficult as the usual first-line antibiotics can be ineffective. Treatment must be prolonged and drugs that are potentially more toxic must be used. Major obstacles in the treatment of DR-TB include a lack of new drugs and a lack of evidence as there have been very few randomized trials in treatment of DR-TB.

Global TB control will not be achieved by focusing only on diagnosis and drug treatment. The impact on patients’ lives and the barriers to care faced by many patients with TB must also be addressed. A particular concern is the social and economic impact on patients and their families. A broader multidisciplinary approach is needed: one which provides social and economic support as well as medical treatment for patients suffering from TB.

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Author information

Authors and Affiliations

  1. Department of Medicine, Yenepoya Medical College, University Road, Deralakatte, Mangalore, Karnataka, 575018, India

    Anurag Bhargava M.D., M.Sc.

  2. Respiratory Division, Montreal Chest Institute, MUHC and McGill University, Room 419, 2155 Guy St., Montreal, QC, Canada, H3H 2R9

    Dick Menzies M.D., M.Sc.

Authors
  1. Anurag Bhargava M.D., M.Sc.
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  2. Dick Menzies M.D., M.Sc.
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Corresponding author

Correspondence to Dick Menzies M.D., M.Sc. .

Editor information

Editors and Affiliations

  1. Haikou VTI Biological Institute, Boston, Massachusetts, USA

    Yichen Lu

  2. Chinese Nat’l Ctr Disease Control and Prevention, Nat’l Center for TB Control & Prevention Chinese Nat’l Ctr Disease Control and Prevention, Beijing, China

    Lixia Wang

  3. National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China

    Hongjin Duanmu

  4. Brookline, Massachusetts, USA

    Chris Chanyasulkit

  5. Vaccine Technologies, Inc., Wellesley, Massachusetts, USA

    Amie J. Strong

  6. National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China

    Hui Zhang

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Bhargava, A., Menzies, D. (2017). Current Options in Treatment and Issues in Tuberculosis Care in Low- and Middle-Income Countries. In: Lu, Y., Wang, L., Duanmu, H., Chanyasulkit, C., Strong, A., Zhang, H. (eds) Handbook of Global Tuberculosis Control. Springer, Boston, MA. https://doi.org/10.1007/978-1-4939-6667-7_8

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  • DOI: https://doi.org/10.1007/978-1-4939-6667-7_8

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