Persons suspected of having TB should be referred for a medical evaluation, which should include:
Positive bacteriologic cultures for M. tuberculosis confirm the diagnosis of TB. Clinicians should not wait for bacteriologic culture results before starting therapy. Therapy should be started when the potential risks of TB exceed the risk of therapy.
Spokane Regional Health District's Tuberculosis Treatment program can provide technical consultation to health care providers in collecting and shipping specimens to Washington State Public Health Laboratory.
For most patients, the preferred regimen for treating TB disease consists of an initial two-month phase of four drugs:
Followed by a four-month continuation phase of isoniazid and rifampin.
Streptomycin may be substituted for ethambutol, but must be given by injection. Ethambutol (or streptomycin) can be discontinued when drug susceptibility results show the infecting organism to be fully drug-susceptible.
The major determinant of the outcome of treatment is patient adherence to the drug regimen. Spokane Regional Health District Tuberculosis Treatment program can provide technical consultation (509) 324-1613.
Careful attention should be paid to measures designed to foster adherence. Ttreating all patients with directly observed therapy (DOT) is strongly recommended.
Multidrug-resistant TB (i.e., TB resistant to both isoniazid and rifampin) presents difficult treatment problems and requires expert consultation, (509) 324-1613.. The consequences of treatment failure and further acquired drug resistance make DOT a high priority for cases of drug-resistant TB.
Treatment of Drug-Susceptible Tuberculosis (Clinical Infectious Disease 2016)
The diagnosis of latent tuberculosis infection (LTBI) has traditionally been based upon results of tuberculin skin testing. However, several whole-blood interferon gamma release assays are now options:
Use the Mantoux tuberculin skin test (TST) or an IGRA to test for Mycobacterium tuberculosis infection. IGRA can be used in all circumstances in which the TST is used, and IGRAs usually can be used in place of (and not in addition to) the TST.
Spokane Regional Health District's Tuberculosis Treatment program, (509) 324-1613, can provide technical consultation to health care providers in collecting and shipping specimens to Washington State Public Health Laboratory.
There are several treatment regimens available for the treatment of LTBI, and providers should discuss options with patients. Persons who are at especially high risk for TB, and either are suspected of nonadherence or are on an intermittent dosing regimen, should be treated using directly observed therapy (DOT). This method of treatment is especially appropriate when a household member is on DOT for TB disease or in institutions and facilities where a staff member can observe treatment.
Spokane Regional Health District Tuberculosis Treatment program can provide technical consultation (509) 324-1613.