II. Indications
- Resistance rate in patient's Community <4%
- Most communities have Tb resistance >4%
- HIV Screening negative
- Immunocompetent
- No prior Tuberculosis Treatment v
III. Management: Overview (requires 2 phases of therapy)
- Background
- Additional regimens are available with less frequent dosing, but with higher risk of failure
- See CDC website for other regimens
- Initial phase: 3-4 drug regimen for 2 months
- Medications (4 used together in initial phase)
- Isoniazid and
- Rifampin and
- Pyrazinamide and
- Ethambutol (unless not indicated by culture)
- Dose timing
- Take once daily for 8 weeks (56 doses) or
- Take five times weekly for 8 weeks (40 doses)
- Given under direct observation
- Medications (4 used together in initial phase)
- Continuation phase: Double therapy for 4-7 months
- Medications (2 used together in continuation phase)
- Dose timing (18 weeks unless otherwise noted below)
- Once daily (125 doses, preferred) or
- Five times per week (90 doses, under direct observation, preferred) or
- Three times per week (54 doses under direct observation, alternative when direct observation schedule is difficult)
- Duration of treatment
- Double therapy for 18 weeks unless exceptions below
- Indications for 7 month continuation phase
- Cavitary pulmonary Tuberculosis
- Positive Sputum Culture after initial phase
- Adjunctive
- Vitamin B6 (Pyridoxine) 25-50 mg daily
- Indicated for Neuropathy risk due to INH (e.g. Diabetes Mellitus, Alcoholism)
- See Isoniazid for details
- Vitamin B6 (Pyridoxine) 25-50 mg daily
IV. Resources
- CDC Tb Guidelines Treatment
- CDC Division of Tuberculosis Elimination