The Management of Tuberculosis

Abstract

This subject has recently been admirably reviewed by Seaton (1978). As he says, all forms of tuberculosis should be treated in the same way, preferably with a chest physician in charge with experience in the problems of the management of antituberculosis chemotherapy. He further points out that this is true of tuberculosis presenting to surgeons, as early diagnosis will often prevent unnecessary surgery. There seems little doubt that drugs alone will be successful in the management of almost all cases of tuberculosis, irrespective of the system involved, provided certain prin-ciples are adhered to. Initially adequate specimens should be sent to the laboratory so that Mycobacterium tuberculosis can be cultured, identified, and its pattern of drug resistance, if any, estimated. This will take 6 to 8 weeks; during this time treatment should be commenced with drugs to which the organism is likely to be sensitive. This primary regimen is continued for at least 8 weeks, or until the drug sensitivities are known. Thereafter 2 drugs are given. Such treatment reduces infectivity quickly by a rapid kill of the organisms and prevents resistance. Careful supervision, probably initially as an inpatient, but more importantly with outpatients, should ensure that the patient is taking the drugs; all the oral drugs should be taken on a fasting stomach. Obvious close contacts should be screened for evidence of tuberculosis.