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Treatment of Tuberculosis: A Review of GuidelinesBrett K; Dulong C; Severn MTreatment of Tuberculosis: A Review of Guidelines-/-CADTH Rapid Response Reports 2020[Mar]; ä (ä): äTuberculosis (TB) is an infectious disease caused by the bacteria Mycobacterium tuberculosis and is transmitted through the air by those who are infected with the bacteria (i.e., coughing). According to the World Health Organization (WHO), roughly a quarter of the world's population is infected with M. tuberculosis and may be at risk for developing the disease. TB typically affects the lungs of a person (i.e., pulmonary TB) but can also spread to other parts of the body (i.e., extrapulmonary TB). TB is prevalent in low and middle income countries, as the disease is associated with poverty, poor sanitation or hygiene practices and being easily transmissible from person to person. However, high income countries, including Canada, still report cases of TB and it is considered an important public health matter. According to the Public Health Agency of Canada (PHAC), Canada has one of the lowest rates of active TB disease in the world. However, annual rates of TB have remained the same in the country since the 1980's rather than steadily declining. In 2017, PHAC reported 1,796 cases of active TB in Canada with migrants and Indigenous peoples bearing the highest rates of active TB in the country and approximately 70% of cases being pulmonary TB.(,) Individuals with TB are categorized into latent TB infection (LTBI) and active TB disease.(,) LTBI refers to an individual who has the M. tuberculosis infection in which the bacteria are alive but are not currently causing active TB disease. Persons with LTBI do not possess any symptoms and are not contagious. However, those with the LTBI can develop active TB disease if they do not receive proper treatment. Active TB disease (also known as active TB) occurs when the TB bacteria begins to multiply and the individual's immune system is compromised, leading to infection. Active TB disease can develop shortly or long after infection, depending on the individual. Symptoms of active TB disease can include excessive coughing, chest pain, weight loss, fever, and fatigue. Persons with active TB disease can spread the TB bacteria to others and are considered contagious. The treatment of TB, both LTBI and active TB disease, is a priority for public health officials. The overall goal of TB treatment is to eradicate the M. Tuberculosis infection. Treating patients for LTBI is done to prevent LTBI from developing into active TB. Treatment for active TB disease is focused on improving the patient's clinical condition, preventing the development or worsening of drug-resistance, and preventing relapse of the disease. The treatments differ for LTBI and active TB disease, although there may be some overlap across therapies. It is important that an individual receives the correct diagnosis of either latent or active TB for the individual to receive optimal treatment. There are several drug options for the treatment of LTBI and active TB disease, and treatment regimens may depend on the age of the individual (e.g., pediatric, adult, elderly patients etc.), co-morbidities (e.g., hepatitis, HIV, renal insufficiency), availability of drugs, the ability to adhere to treatment, and whether the TB is drug-susceptible.(,) There are numerous guidelines published on TB treatment, and these guidelines may vary in quality and the topics covered, which may make it difficult for health care professionals to select the optimal treatment for patients with TB. The purpose of this report is to review and critically appraise the evidence-based guidelines regarding the treatment of TB. This report is part of series of evidence reviews on TB guidelines and can serve as a guidance document to identify which guidelines include recommendations for the treatment of latent and active TB and the strength of the guidelines. This report does not cover recommendations regarding the treatment of multi-drug resistant TB, or treating TB in people with HIV or conditions that compromise the immune system, as these topics are covered in separate reports.(,) This report focuses on treatment strategies for LTBI and active TB disease. This report is a component of a larger CADTH Condition Level Review on TB. A condition level review is an assessment that incorporates all aspects of a condition, from prevention, detection, treatment, and management. For more information on CADTH's Condition Level Review of TB, please visit the project page (https://www.cadth.ca/tuberculosis).ä |
