Tuberculosis (TB) has emerged as a global public health epidemic. Despite
decreasing numbers of cases in the United States since 1992, TB remains a
serious public health problem among certain patient populations and is highly
prevalent in many urban areas. The responsibility for prescribing an appropriate
drug regimen and ensuring that treatment is completed is assigned to the public
health program or the clinician not to the patient. The initial prescribed
regimen for the treatment of TB usually consists of 4 drugs: isoniazid, rifampin,
pyrazinamide, and ethambutol. The minimum length for the treatment of drug-susceptible
TB with a rifampin-based regimen is 6 to 9 months. Providing medications directly
to the patient and watching him/her swallow the anti-TB drugs, which is termed directly observed therapy, is recommended for all patients
diagnosed with TB and can help ensure higher completion rates, prevent the
emergence of drug resistant TB, and enhance TB control. There has been renewed
interest in the treatment of those with latent TB infection as a TB-control
strategy in the United States for eliminating the large reservoir of individuals
at risk for progression to TB. The 2 broad categories of persons who should
be tested for latent TB infection are those who are likely to have been recently
infected (such as contacts to infectious TB cases) and persons who are at
increased risk of progression to TB disease following infection with Mycobacterium tuberculosis (eg, human immunodeficiency
virus infection and selected medical conditions; recent immigrants to the
United States from high TB-burden countries). The preferred regimen for the
treatment of latent TB infection is 9 months of isoniazid. There is now renewed
interest in and great need for the development of new drugs to treat TB and
latent TB infection.