In 2018, tuberculosis (TB) was still among the top 10 leading causes of death, and the leading infectious agent, above HIV/AIDS. An estimated 10 million cases occurred in 2018, with 1.2 million deaths in people uninfected with HIV, and another 250,000 cases of HIV-associated TB. Among all TB cases, 8–6% were HIV infected; 57% were men, 32% women and 11% children (<15 years). About 500,000 cases of rifampicin resistant RR-TB also occurred. Between 2000 and 2018 TB incidence fell on average about 1.6% annually, and 2% between 2017 and 2018. The new global control targets will be presented and recent changes to guidelines positioned in this new scenario.
Guidelines for TB management from the UK, US and WHO were reviewed for recent changes. NICE’s 2016 guidance not to screen contacts of non-pulmonary TB met with widespread criticism, but has recently been supported by a cost-effectiveness analysis. A 2019 meta-analysis of the seminal 2014 studies, OFLOTUB, ReMOX and RIFAQUIN trials showed that while none of those trials showed non-inferiority of a four month fluoroquinolone-containing regimen in all patients, those with low smear grade or no cavitation may be treated with 4-month rifampicin containing regimens. ATS/CDC/IDSA guidelines reflect this, but had not been accepted in the UK by October 2019. WHO has recently recommended the use of new agents in the treatment of rifampicin and multi-drug resistant TB. The rapidly-evolving picture of treatment recommendations for MDR-TB will be explained.
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