Treatment of Tuberculosis in Patients with Sarcopenia

Recommended Treatment Regimen

The American Thoracic Society recommends a treatment regimen that includes at least five medications in the intensive phase and four medications in the continuation phase for patients with tuberculosis and sarcopenia 1
The intensive phase should last between 5 and 7 months after culture conversion 3
The total duration of treatment should be between 15 and 21 months after culture conversion 2
For patients with pre-XDR and XDR tuberculosis, a total treatment duration of 15 to 24 months after culture conversion is suggested 2

A fluoroquinolone of the latest generation, such as levofloxacino or moxifloxacino, is recommended 2
Bedaquilina is recommended 2
Linezolid is suggested 2
Clofazimina is suggested 2
Cycloserine is suggested 2
Ethambutol is suggested only when other more effective medications cannot be used to achieve a total of five medications in the regimen 2
Pyrazinamide is suggested in a regimen for the treatment of patients with MDR-TB when the M. tuberculosis isolate has not shown resistance to pyrazinamide 2

Liver function should be evaluated before initiating treatment 4, 5
Regular monitoring of liver function is necessary for patients with known chronic liver disease, weekly for two weeks and then every two weeks for the first two months 4, 5
Renal function should be evaluated before initiating treatment with streptomycin or ethambutol 4, 5
A visual acuity test with the Snellen chart should be performed before prescribing ethambutol 4, 5
If AST/ALT levels increase to five times normal or bilirubin increases, rifampicin, isoniazid, and pyrazinamide should be discontinued 4, 5

Directly observed therapy (DOT) is recommended to ensure adherence to treatment and minimize adverse effects 1

More studies are needed on the optimization of linezolid dosage and duration in regimens for MDR-TB 6
Additional research is required on the role of carbapenems in regimens for MDR-TB 6
It is essential to identify factors that determine the optimal duration of treatment, such as history of previous treatment, baseline resistance patterns, disease site, and age 6