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Fact Sheets
Treatment of Drug-Susceptible Tuberculosis Disease
in Persons Not Infected with HIV
Last Updated: March 2003
Introduction
In February 2003, the American Thoracic Society (ATS), the Centers
for Diseases Control and Prevention (CDC), and the Infectious Diseases
Society of America (IDSA) released new guidelines for the treatment
of TB. This fact sheet will provide key points about culture-positive
pulmonary TB from these guidelines; however, please refer to the
Treatment of Tuberculosis1 for complete recommendations.
Treating TB disease benefits not only the individual patient but
the community as a whole. Thus, any health care provider undertaking
treatment of a patient with TB, whether a public health or private
practitioner, is assuming a public health function that includes
the responsibility for not only prescribing an appropriate regimen
but also ensuring the patient's adherence to the regimen until treatment
is completed.
Recommended Regimens
There are 10 drugs currently approved by the U.S. Food and Drug
Administration (FDA) for treating tuberculosis (TB). Of the approved
drugs, the first-line anti-TB agents that form the core of treatment
regimens include
- isoniazid (INH),
- rifampin (RIF),
- ethambutol (EMB), and
- pyrazinamide (PZA).
Regimens for treating TB have an initial phase of 2 months,
followed by a choice of several options for the continuation
phase of either 4 or 7 months. The continuation phase should
be extended to 28 weeks for patients who have cavitation on the
initial chest film and positive sputum cultures after 2 months
of treatment. Treatment completion is determined by the number of
doses ingested over a given period of time. Although basic TB regimens
are broadly applicable, there are modifications that should be made
under special circumstances (i.e., HIV infection, drug resistance,
pregnancy, or treatment of children). Listed below are the basic
regimens; please refer to Treatment of Tuberculosis1
for all options for the treatment of drug-susceptible TB.
Preferred
Regimen |
Alternative
Regimen |
Alternative
Regimen |
Initial Phase
Daily INH, RIF, PZA, and EMB* for 56 doses (8 weeks) |
Initial Phase
Daily INH, RIF, PZA, and EMB* for 14 doses (2 weeks), then
twice weekly for 12 doses (6 weeks) |
Initial Phase
Thrice-weekly INH, RIF, PZA, and EMB* for 24 doses (8 weeks) |
Continuation Phase
Daily INH and RIF for 126 doses (18 weeks)
or
Twice-weekly INH and RIF for 36 doses (18 weeks)
| Continuation Phase
Twice-weekly INH and RIF for 36 doses (18 weeks) |
Continuation Phase
Thrice-weekly INH and RIF for 54 doses (18 weeks) |
*EMB can be discontinued if drug susceptibility studies demonstrate
susceptibility to first-line drugs.
A continuation phase of once-weekly INH/rifapentine can be used
for HIV negative patients who do not have cavities on the chest
film and who have negative acid-fast bacilli (AFB) smears
at the completion of the initial phase of treatment.
Case Management
Patient-centered case management should be used in the treatment
strategy with an adherence plan that includes directly observed
therapy (DOT). DOT is a strategy in which a health care worker or
another designated person watches the TB patient swallow each dose
of the anti-TB drugs. All patients taking drugs fewer than 7 days
per week (e.g., 1, 2, 3, or 5 days a week) must receive DOT.
Follow-up Evaluations
Sputum specimens for microscopic examination and culture should
be obtained from patients diagnosed with TB at a minimum of monthly
intervals until two consecutive specimens are negative on culture. It
is critical to obtain a sputum specimen at the end of the initial
phase (2 months) to determine if the continuation phase should be
extended. In addition, it is essential that patients have clinical
evaluations at least monthly to identify possible adverse effects
of the anti-TB medications and to assess adherence. All patients
with TB should have counseling and testing for HIV.
For More Information
- Centers
for Disease Control and Prevention. Treatment of Tuberculosis.
(PDF) MMWR 2003;52(No. RR-11).
Errata
Last Reviewed: 05/18/2008 Content Source: Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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