Interventions for Tuberculosis Control and Elimination 2002

Chemotherapy
Summary – the role
of specific interventions
Chemotherapy of tuberculosis is universally indicated for all newly identified
tuberculosis patients. No patient with newly diagnosed tuberculosis
should be denied treatment.
Chemotherapy is the most powerful weapon in tuberculosis control.
It carries individual benefit by reducing morbidity and fatality. It has epidemiologic
impact by cutting the chain of transmission effectively if effective
treatment leading to cure of individual patients can be assured.
A national tuberculosis program must choose and recommend efficacious,
standardized treatment regimens and must ensure both that they are
administered carefully to prevent emergence of drug resistance and the cure
of the patient.
The limited armamentarium of available anti-tuberculosis medications
imposes particular constraints on the use of the most efficacious drugs.
Regimens and their administration should be designed to prevent the emergence
of chronic excretors with incurable, multidrug-resistant tuberculosis.
The following six drugs are currently on the essential drug list:
• Isoniazid is the cornerstone of every first-line regimen. It has the most
potent early bactericidal activity of all known drugs. It rarely causes
adverse drug events, the most important of which is hepatic injury,
which may result in hepatitis in a small fraction of patients. It interacts
with several medications, but the single most important is its
enhancement of the effect of anti-epileptics.
• Rifampicin has unique relapse-preventing properties that allowed the
duration of chemotherapy to be shortened to nine months or fewer. It
is a superbly tolerated drug that may, however, complicate isoniazidassociated
hepatitis, mainly by supporting cholestasis. Immunologicallylinked
events might be serious and life-threatening, but are very rare.
Rifampicin interacts with a multitude of other medications: the most
important interactions in practice are reduction of the efficacy of oral
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