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Executive Summary: Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis

  1. Andrew Vernon8
  1. 1University of California, San Francisco
  2. 2Johns Hopkins University, Baltimore, Maryland
  3. 3California Department of Public Health, Richmond
  4. 4McMaster University, Hamilton, Ontario, Canada
  5. 5National Jewish Health, Denver, Colorado
  6. 6World Health Organization, Geneva, Switzerland
  7. 7Tuberculosis Control Section, San Francisco Department of Public Health, California
  8. 8Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
  9. 9Harvard Medical School, Boston, Massachusetts
  10. 10McGill University, Montreal, Quebec, Canada
  11. 11WHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri Care and Research Institute, Tradate, Italy
  12. 12Tuberculosis Control Program, Seattle and King County Public Health, and University of Washington, Seattle
  13. 13Ethics Advisory Group, International Union Against TB and Lung Disease, Paris, France
  14. 14University of Florida, Gainesville
  15. 15Boston University, Massachusetts
  16. 16Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
  17. 17University of Sassari, Italy
  18. 18Baylor College of Medicine, Houston, Texas
  1. Correspondence: P. Nahid, University of California, San Francisco, San Francisco General Hospital, Pulmonary and Critical Care Medicine, 1001 Potrero Ave, 5K1, San Francisco, CA 94110 (pnahid{at}ucsf.edu).
  1. These guidelines were endorsed by the European Respiratory Society (ERS) and the US National Tuberculosis Controllers Association (NTCA). It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The sponsoring and endorsing societies consider adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.

Abstract

The American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America jointly sponsored the development of this guideline for the treatment of drug-susceptible tuberculosis, which is also endorsed by the European Respiratory Society and the US National Tuberculosis Controllers Association. Representatives from the American Academy of Pediatrics, the Canadian Thoracic Society, the International Union Against Tuberculosis and Lung Disease, and the World Health Organization also participated in the development of the guideline. This guideline provides recommendations on the clinical and public health management of tuberculosis in children and adults in settings in which mycobacterial cultures, molecular and phenotypic drug susceptibility tests, and radiographic studies, among other diagnostic tools, are available on a routine basis. For all recommendations, literature reviews were performed, followed by discussion by an expert committee according to the Grading of Recommendations, Assessment, Development and Evaluation methodology. Given the public health implications of prompt diagnosis and effective management of tuberculosis, empiric multidrug treatment is initiated in almost all situations in which active tuberculosis is suspected. Additional characteristics such as presence of comorbidities, severity of disease, and response to treatment influence management decisions. Specific recommendations on the use of case management strategies (including directly observed therapy), regimen and dosing selection in adults and children (daily vs intermittent), treatment of tuberculosis in the presence of HIV infection (duration of tuberculosis treatment and timing of initiation of antiretroviral therapy), as well as treatment of extrapulmonary disease (central nervous system, pericardial among other sites) are provided. The development of more potent and better-tolerated drug regimens, optimization of drug exposure for the component drugs, optimal management of tuberculosis in special populations, identification of accurate biomarkers of treatment effect, and the assessment of new strategies for implementing regimens in the field remain key priority areas for research. See the full-text online version of the document for detailed discussion of the management of tuberculosis and recommendations for practice.

Key words

  • Received June 4, 2016.
  • Accepted June 6, 2016.
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