Treatment of active tuberculosis

A. Suspected TB should be treated empirically with a 4 drug combination. The four-drug regimen consists of isoniazid, rifampin, pyrazinamide, and ethambutol. Patients should be treated for 8 weeks with the four-drug regimen, followed by 16 weeks of INH and rifampin daily or 2-3 times weekly. HIV-positive patients should be treated for a total of 9 months and at least 6 months following culture conversion to negative.

B. If multi-drug resistant TB (resistant to both INH and RIF) is encountered, therapy should be more prolonged and guided by antibiotic sensitivities. Directly observed therapy, on a twice per week basis, should be instituted when compliance is questioned.

Drug

Daily Dose

Two Times/week Dose

Three Times/week Dose

Isoniazid (INH)

5 mg/kg, max 300 mg

15 mg/kg, max 900 mg

15 mg/kg, max 900 mg

Rifampin (RIF)

10 mg/kg, max 600 mg

10 mg/kg, max 600 mg

10 mg/kg, max 600 mg

Pyrazinamide (PZA)

2 g

50-70 mg/kg, max 4 g

g

Ethambutol (EMB)

5-25 mg/kg, max 2.5 g

g

25-30 mg/kg, max 2.5 g

g

25-30 mg/kg, max 1.5 g

g

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