miércoles, 17 de agosto de 2016

Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis

Dear Colleague:

I am pleased to announce the release of the 2016 Treatment of Drug-Susceptible Tuberculosis Guidelines. The American Thoracic Society (ATS), Centers for Disease Control and Prevention (CDC), and the Infectious Diseases Society of America (IDSA) sponsored the development of the guidelines, and they have been endorsed by the European Respiratory Society and the U.S. National Tuberculosis Controllers Association. The guidelines update the previous tuberculosis (TB) treatment guidelines published by ATS/CDC/IDSA in 2003.

The newly released guidelines provide recommendations on the clinical and public health management of tuberculosis (TB) in children and adults in well-resourced settings. The guidelines provide evidence-based recommendations that were developed with the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology. 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. Among the nine recommendations for the treatment of drug-susceptible TB, the guidelines provide recommendations on the management of patients who are co-infected with TB disease and HIV. They also include sections on TB disease in special situations, such as extrapulmonary TB, culture-negative pulmonary TB, and TB during pregnancy and breastfeeding, among others.

Help us spread the word about the new TB treatment guidelines. We have provided a matte article that can be used to share this information with your partners and stakeholders. Please feel free to revise and personalize for your own media outlets. For more information on the management of TB disease and practice recommendations, please see the full version of the guidelines in Clinical Infectious Diseases.

Sincerely,

Philip LoBue, MD, FACP, FCCP

Director,

Division of Tuberculosis Elimination

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis

+Author Affiliations

¹University of California, San Francisco
²Johns Hopkins University, Baltimore, Maryland
³California Department of Public Health, Richmond
⁴McMaster University, Hamilton, Ontario, Canada
⁵National Jewish Health, Denver, Colorado
⁶World Health Organization, Geneva, Switzerland
⁷Tuberculosis Control Section, San Francisco Department of Public Health, California
⁸Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
⁹Harvard Medical School, Boston, Massachusetts
¹⁰McGill University, Montreal, Quebec, Canada
¹¹WHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri Care and Research Institute, Tradate, Italy
¹²Tuberculosis Control Program, Seattle and King County Public Health, and University of Washington, Seattle
¹³Ethics Advisory Group, International Union Against TB and Lung Disease, Paris, France
¹⁴University of Florida, Gainesville
¹⁵Boston University, Massachusetts
¹⁶Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
¹⁷University of Sassari, Italy
¹⁸Baylor College of Medicine, Houston, Texas

Correspondence: P. Nahid, University of California, San Francisco, San Francisco General Hospital, Pulmonary and Critical Care Medicine, 1001 Potrero Ave, 5K1, San Francisco, CA 94110 (pnahid@ucsf.edu).

These guidelines were endorsed by the European Respiratory Society (ERS) and the US National Tuberculosis Controllers Association (NTCA). It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The sponsoring and endorsing societies consider adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.

Abstract

The American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America jointly sponsored the development of this guideline for the treatment of drug-susceptible tuberculosis, which is also endorsed by the European Respiratory Society and the US National Tuberculosis Controllers Association. Representatives from the American Academy of Pediatrics, the Canadian Thoracic Society, the International Union Against Tuberculosis and Lung Disease, and the World Health Organization also participated in the development of the guideline. This guideline provides recommendations on the clinical and public health management of tuberculosis in children and adults in settings in which mycobacterial cultures, molecular and phenotypic drug susceptibility tests, and radiographic studies, among other diagnostic tools, are available on a routine basis. For all recommendations, literature reviews were performed, followed by discussion by an expert committee according to the Grading of Recommendations, Assessment, Development and Evaluation methodology. Given the public health implications of prompt diagnosis and effective management of tuberculosis, empiric multidrug treatment is initiated in almost all situations in which active tuberculosis is suspected. Additional characteristics such as presence of comorbidities, severity of disease, and response to treatment influence management decisions. Specific recommendations on the use of case management strategies (including directly observed therapy), regimen and dosing selection in adults and children (daily vs intermittent), treatment of tuberculosis in the presence of HIV infection (duration of tuberculosis treatment and timing of initiation of antiretroviral therapy), as well as treatment of extrapulmonary disease (central nervous system, pericardial among other sites) are provided. The development of more potent and better-tolerated drug regimens, optimization of drug exposure for the component drugs, optimal management of tuberculosis in special populations, identification of accurate biomarkers of treatment effect, and the assessment of new strategies for implementing regimens in the field remain key priority areas for research. See the full-text online version of the document for detailed discussion of the management of tuberculosis and recommendations for practice.