Susceptible Tuberculosis Treatment

Resistance rate in patient's Community <4%
1. Most communities have Tb resistance >4%
HIV Screening negative
Immunocompetent
No prior Tuberculosis Treatment v

Background
1. Additional regimens are available with less frequent dosing, but with higher risk of failure
2. See CDC website for other regimens
Initial phase: 3-4 drug regimen for 2 months
1. Medications (4 used together in initial phase)
  1. Isoniazid and
  2. Rifampin and
  3. Pyrazinamide and
  4. Ethambutol (unless not indicated by culture)
2. Dose timing
  1. Take once daily for 8 weeks (56 doses) or
  2. Take five times weekly for 8 weeks (40 doses)
    1. Given under direct observation
Continuation phase: Double therapy for 4-7 months
1. Medications (2 used together in continuation phase)
  1. Isoniazid and
  2. Rifampin
2. Dose timing (18 weeks unless otherwise noted below)
  1. Once daily (125 doses, preferred) or
  2. Five times per week (90 doses, under direct observation, preferred) or
  3. Three times per week (54 doses under direct observation, alternative when direct observation schedule is difficult)
3. Duration of treatment
  1. Double therapy for 18 weeks unless exceptions below
  2. Indications for 7 month continuation phase
    1. Cavitary pulmonary Tuberculosis
    2. Positive Sputum Culture after initial phase
Adjunctive
1. Vitamin B6 (Pyridoxine) 25-50 mg daily
  1. Indicated for Neuropathy risk due to INH (e.g. Diabetes Mellitus, Alcoholism)
  2. See Isoniazid for details