Medical co-morbidities, substance use-disorders, advanced age and pregnancy can complicate management of TB.1,2 Alterations in immunologic control of TB infection may increase the risk of reactivation and lead to more severe forms of TB disease.1 Co-morbidity may also lead to slower TB treatment response and higher rates of TB relapse.1 As a result, extension of TB treatment duration is sometimes required to optimize TB treatment outcomes.
These special populations may also differ in absorption, metabolism and clearance of TB drugs. Thus, special attention to dosing of TB medications is needed and, in some groups, therapeutic drug monitoring is recommended.3 Increased susceptibility to adverse events in some groups may mandate closer monitoring and support, including for drug-drug interactions and overlapping toxicities.
Finally, there is often a lack of comparative clinical data directly relevant to these special populations, as these groups are often excluded from clinical trials due to concerns over harm.
Given these challenges and limitations in the clinical data, consultation with a TB specialist and an experienced pharmacist is strongly recommended. Furthermore, it is important to initiate close collaboration with the patient’s medical and allied health care team throughout the TB treatment course.
Here we review additional considerations in TB management of special populations. For each population we will review the impact on epidemiology, clinical presentation, treatment outcomes and management.
Switch To: Français