Recommendations For Treatment Of Active Tuberculosis

The most commonly used regimen for drug-susceptible tuberculosis consists of isoniazid, rifampin, and pyrazinamide daily for 2 months, followed by isoniazid and rifampin daily or two to three times a week for 4 months. If isoniazid resistance is suspected, ethambutol or streptomycin should be added to the regimen until the susceptibility of the mycobacterium is determined. This regimen will provide at least two drugs to which the M. tuberculosis isolate is susceptible in more than 95% of patients in the United States.

Alternative regimens include isoniazid, rifampin, pyrazinamide, and either streptomycin or ethambutol for 2 weeks followed biweekly with the same regimen for 6 weeks, and subsequently with biweekly administration of isoniazid and rifampin for 16 weeks. In HIV-infected patients the treatment should be prolonged 9 to 12 months or sometimes even longer if the response is slow. Treatment of tuberculosis is more challenging in an HIV-infected population taking highly active anti-retroviral therapy because of drug interactions.

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