Bedaquiline (bed ak' wi leen; Sirturo – Janssen), a diarylquinoline antimycobacterial, has been given accelerated approval by the FDA as an orphan drug for use in addition to other drugs for treatment of adults with multidrug-resistant pulmonary tuberculosis (MDR-TB). It is the first drug approved specifically to treat MDR-TB.

Tuberculosis (TB) is still a common cause of death worldwide, and the prevalence of drug-resistant TB poses challenges to its treatment and control. Guidelines with detailed management recommendations are available from the American Thoracic Society, Centers for Disease Control and Prevention (CDC) and Infectious Diseases Society of America (IDSA).

Even though the incidence continues to decline in the United States, tuberculosis (TB) is still a common cause of death worldwide, and the prevalence of drug-resistant TB poses severe challenges to its treatment and control. Guidelines with detailed management recommendations are available from the Centers for Disease Control and Prevention (CDC), American Thoracic Society and Infectious Diseases Society of America (IDSA).

Many drugs can cause psychiatric symptoms, but a causal connection is often difficult to establish. Psychiatric symptoms that emerge during drug treatment could also be due to the underlying illness, previously unrecognized psychopathology, or psychosocial factors. The withdrawal of some drugs can cause symptoms such as anxiety, psychosis, delirium, agitation or depression.

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Information about empirical treatment of bacterial infections, emerging trends in antimicrobial resistance, new drugs and new data about older drugs continue to become available. Usual pathogens and empiric treatment for some common types of infections are summarized in the text and a table listing the drugs of choice and alternatives for each pathogen begins on page 40. The recommendations made here are based on the results of susceptibility studies, clinical trials and the opinions of Medical Letter consultants.

Even though the incidence continues to decline, tuberculosis (TB) is still a problem in the United States. Treatment of TB can be divided into treatment of latent infection and treatment of active disease. Atable listing the first-line drugs used for treatment of TB with their doses and adverse effects can be found on page 16. Other guidelines with more detailed management recommendations are available.

Tuberculosis (TB) is still a problem in the United States, even though the incidence continues to decline in most of the country (MMWR Morbid Mortal Wkly Rep 2004; 53:209). Treatment of TB can be divided into treatment of latent infection diagnosed by a positive PPD and treatment of active clinical TB. Guidelines with detailed management recommendations are available from the US Centers for Disease Control and Prevention (CDC) (MMWR Morbid Mortal Wkly Rep 2003; 52RR-11:1).

New drugs for bacterial infections and new information about older drugs continue to become available. Empirical treatment of some common bacterial infections is discussed in this article. A table listing the drugs of choice and alternatives for each pathogen begins on page 18. These recommendations are based on results of susceptibility studies, clinical trials and the opinions of Medical Letter consultants. Local resistance patterns should be taken into account. Trade names are listed on page 24.

Many drugs can cause psychiatric symptoms, but a causal connection is often difficult to establish. Psychiatric symptoms that emerge during drug treatment may also be due to the underlying illness, previously unrecognized psychopathology, or psychosocial factors. The withdrawal of some drugs can cause symptoms such as anxiety, psychosis, delirium, agitation or depression.

Older patients are especially susceptible to drug-induced cognitive impairment. They are more likely to be taking multiple drugs, to have higher blood levels of those drugs because of renal or hepatic dysfunction, and to have pre-existing cognitive problems that make it difficult to detect the role of drugs causing new symptoms or making old ones worse.

Tuberculosis (TB) continues to be a major problem in the United States, particularly in areas where drug resistance is common (Morbid Mortal Weekly Rep, 44:387, May 26, 1995). Since poor compliance is the most important cause of treatment failure and is associated with emergence of drug resistence, some experts now recommend that all patients take drugs for TB under direct observation (SE Weis et al, N Engl J Med, 330:1179, 1994; R Bayer and D Wilkinson, Lancet, 345:1545, June 17, 1995).

The rising incidence of tuberculosis (TB) has been accompanied by a dramatic increase in drug resistance in some areas of the USA (TR Frieden et al, N Engl J Med, 328:521, 1993). Since poor compliance is the most important cause of treatment failure and associated with emergence of drug resistance, some experts now recommend that patients with TB take their drugs under direct obeservation (MD Iseman et al, N Engl J Med, 329:576, 1993).

After many years of decline in the USA, the incidence of tuberculosis (TB) has recently increased, partly because the disease occurs more frequently in patients with human immunodeficiency virus (HIV) infection and in the homeless (PF Barnes et al, N Engl J Med, 324:1644, 1991; Morbid Mortal Weekly Rep, 40:869, Dec 20, 1991).