Treatment of pulmonary tuberculosis

Tuberculosis (TB) remains the world's leading cause of death from a single infectious disease. In addition, the incidence of TB is high in South Korea. Effective TB control requires early diagnosis and initiation of appropriate treatment. Therefore, it is very important for clinicians to understand evidence-based practical recommendations and to be familiar with up-to-date treatment regimens. In this review, we first describe anti-TB drugs, including new drugs. Secondly, we discuss the treatment of drug-susceptible TB. Finally, we present treatment strategies for drug-resistant TB, which is divided into isoniazid-resistant TB, rifampin-resistant TB, and multi-drug resistant TB. For the treatment of drug-susceptible TB, we recommend 2 months of 4 drugs (isoniazid, rifampin, ethambutol, and pyrazinamide) followed by 4 months of 2 drugs (isoniazid and rifampin). For the treatment of isoniazid-resistant TB, we recommend 6 to 9 months of 4 drugs (rifampin, ethambutol, pyrazinamide, and levofloxacin or moxifloxacin). For the treatment of multi-drug resistant TB (MDR-TB), we recommend a minimum of 5 secondary drugs, including an injectable agent and quinolone. Although the World Health Organization recommended a shorter MDR-TB regimen in 2016, the Korean guidelines for tuberculosis have not yet accepted the shorter regimen. The treatment regimen of TB differs depending on the drug resistance pattern. Therefore, it is important to treat TB properly after confirming the drug resistance pattern. In addition, as new drugs are developed, new treatment guidelines for MDR-TB should be developed that are appropriate for circumstances in Korea.