Although tuberculosis (TB) is no longer a leading cause of death in the United States, efforts to eliminate this potentially fatal disease are critical. After two decades of steady decline, the number of reported U.S. TB cases rose slightly in 2015 to 9,563, according to provisional data released by CDC. Each day, health care professionals work diligently to treat patients who have TB disease. The Centers for Disease Control and Prevention (CDC) is committed to supporting this important work and has joined the American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA) in developing the newly released 2016 Treatment of Drug-Susceptible Tuberculosis Guidelines.
The guidelines update the previous TB treatment guidelines published by ATS/CDC/IDSA in 2003, and have also been endorsed by the European Respiratory Society and the U.S. National Tuberculosis Controllers Association. The current guidelines provide strong recommendations on the management of patients who are co-infected with TB and HIV. The new guidelines recommend that patients begin antiretroviral therapy (ART) while being treated for TB, and provide greater precision about the recommended timing of initiation of ART.
The current guidelines provide evidence-based recommendations that were developed with the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology, another difference between the current guidelines and their predecessor. GRADE involves structured literature review, systematic reviews and meta-analyses of combined data, and expert discussion to assess the certainty in the evidence and determine the strength of each recommendation.
The new guidelines recommend comprehensive care of all patients with TB disease (known as ‘case management’). Case management includes the use of directly observed therapy (DOT), which improves treatment success. In DOT, a health care provider watches the patient swallow each dose of medication during the six-month course of therapy. Case management is essential to ensure TB treatment is effective, the guidelines note.
For more information on the management of TB disease and practice recommendations, health professionals who care for and manage patients with TB disease should refer to the full version of the guidelines online. They have been published by IDSA in Clinical Infectious Diseases.