[Trends in tuberculosis treatment duration].
The two principal characteristics of tuberculosis treatment are its length (several months) and the need to use several antibiotics simultaneously (multiple drug therapy). Multiple drug therapy is intended to prevent the selection of resistant mutants at the beginning of treatment, when the bacilli population is largest. The length of treatment is due to dormant bacilli, which are much more difficult for antibiotics to kill than actively multiplying bacilli are. Rifampin and pyrazinamide are the most potent drugs against these dormant bacilli. The so-called sterilizing activity of rifampin has reduced the duration of treatment from 18 to 9 months, and the contribution of pyrazinamide reduced this time still further, to 6 months. When one of these drugs cannot be used because of resistance or toxicity, duration of treatment increases to the earlier levels. In the extreme case of multidrug-resistant tuberculosis where neither isoniazid nor rifampin can be used, and sometimes even not pyrazinamide, treatment is recommended for 18 to 24 months. New antituberculosis drugs under development allow us to envision further reduction in the duration of treatment of both drug-resistant and drug-sensitive tuberculosis.
Veziris
Nicolas
N
Service de pneumologie,; Laboratoire de bactériologie, Groupe hospitalier Pitié-Salpêtrière, Assistance publique Hôpitaux de Paris, Centre national de référence de la résistance des mycobactéries aux antituberculeux, Faculté de médecine Pierre et Marie Curie, Université Paris 6, Paris (75). Electronic address: veziris@chups.jussieu.fr.
Aubry
Alexandra
A
Laboratoire de bactériologie, Groupe hospitalier Pitié-Salpêtrière, Assistance publique Hôpitaux de Paris, Centre national de référence de la résistance des mycobactéries aux antituberculeux, Faculté de médecine Pierre et Marie Curie, Université Paris 6, Paris (75).
Truffot-Pernot
Chantal
C
Laboratoire de bactériologie, Groupe hospitalier Pitié-Salpêtrière, Assistance publique Hôpitaux de Paris, Centre national de référence de la résistance des mycobactéries aux antituberculeux, Faculté de médecine Pierre et Marie Curie, Université Paris 6, Paris (75).
D000818:Animals; D000904:Antibiotics, Antitubercular / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use; D004195:Disease Models, Animal; D024881:Drug Resistance, Bacterial / Q000235:genetics; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics; D004359:Drug Therapy, Combination; D006801:Humans; D007538:Isoniazid / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D051379:Mice; D009154:Mutation; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000235:genetics; D011718:Pyrazinamide / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D012008:Recurrence; D012293:Rifampin / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D013997:Time Factors; D014376:Tuberculosis / Q000188:drug therapy* / Q000382:microbiology; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000382:microbiology
D000904:Antibiotics, Antitubercular; D000995:Antitubercular Agents; D011718:Pyrazinamide; D007538:Isoniazid; D012293:Rifampin