Recurrent tuberculosis: definitions and treatment regimens

Within the National Tuberculosis Control Programme of Malawi, misunderstand ings sometimes occur about the diagnosis and management of recurrent tuberc ulosis (TB). Patients with smear-positive pulmonary tuberculosis (PTB) who have had a previous, treated episode of smear-negative TB may be registered as 'new cases' rather than relapse cases, and thus denied the benefits of a retreatment regimen. Patients with a recurrent episode of smear-negative PTB or extra-pulmonary TB (EPTB) may also be wrongly registered as 'new cas es' rather than recurrent cases. International guidelines about the treatme nt of recurrent smear-negative PTB and EPTB are not explicit, resulting in confusion about how best to manage these cases. It is suggested that all su ch cases be considered for re-treatment regimen because of concerns about a cquired drug resistance. WHO and IUATLD guidelines on the diagnosis and man agement of recurrent and relapse TB need to be improved, and operational re search studies should be conducted to provide answers to some outstanding q uestions.