Medical treatment of pulmonary tuberculosis

Tuberculosis (TB) remains among the leading causes of death among treatable infectious diseases. Treatment of pulmonary TB has progressed enormously from the initial monotherapy options offered in the 1940s. However, while a standard 6-month course of chemotherapy has proved to be extremely effective in treating drug-susceptible TB cases, the appearance of drug-resistant TB has complicated the management of pulmonary TB. Rapid drug susceptibility testing is strongly advised in order to avoid inadequate treatment at the time of TB diagnosis, and the regimen prescribed should include at least four potentially active drugs and have an increased duration of treatment. Drug-drug interactions between anti-TB and anti-HIV drugs also increase poor treatment outcome rates and the occurrence of adverse events. However, therapeutic drug monitoring can be used as a diagnostic tool to assess the dosing, through evaluation of blood concentrations. Despite the growing problem of drug resistance, hope is generated by the growing evidence that old drugs may still be useful and that new effective and welltolerated drugs are now available. Today, patients can benefit from novel drugs and regimens, but it is necessary to administer them carefully to avoid the real risk of losing their effectiveness in a time shorter than that necessary to develop them.