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TB Facts for Health Care Workers

Treatment of Tuberculosis

Regimens for the Treatment of Tuberculosis

TB is usually curable if effective treatment is instituted without delay. TB treatment regimens must contain multiple drugs to which the organisms are susceptible. Treatment with a single drug can lead to the development of a bacterial population resistant to that drug. Likewise, the addition of a single drug to a failing antituberculosis regimen can lead to resistance to that drug.

There are four basic regimens* recommended for treating adults with culture-positive TB caused by organisms that are known or presumed to be susceptible to INH, RIF, PZA, and ethambutol (EMB). Each treatment regimen consists of an initial 2-month treatment phase followed by a continuation phase. The continuation phase is generally 4 months for the majority of patients. All TB drugs should be given together rather than in divided doses.

The continuation phase should be extended to 7 months for a total of 9 months (an additional 3 months) for patients

  • Who have cavitary pulmonary TB on a chest radiograph at diagnosis and positive sputum cultures at completion of the initial phase; or
  • Whose initial phase of treatment did not include PZA; or
  • Who are being treated with once-weekly INH and rifapentine (RPT) (only in HIV-negative patients without cavitation for pulmonary disease) and whose sputum culture is positive at completion of the initial phase.

Treatment completion is determined primarily by the number of doses ingested within a specified time frame. The duration of therapy depends on the drugs used, the drug susceptibility test results, and the patient’s response to therapy. All 6-month regimens must contain INH, RIF, and initially, PZA; all regimens of 9 months or less must contain INH and RIF.

Management of HIV-related TB disease is complex, and the clinical and public health consequences associated with the failure of treatment are serious. The care for HIV-related TB should be provided by or in consultation with experts in the management of both TB and HIV disease. Every effort should be made to use a rifamycin-based regimen for the entire course of therapy.

Recommendations for the treatment of TB in HIV-infected adults are the same as for HIV-negative patients, with two exceptions:

  • Once-weekly administration of INH/rifapentene in the continuation phase should not be used in any HIV-positive patient
  • Twice-weekly administration of INH/RIF or rifabutin in the continuation phase should not be used for patients with CD4+ lymphocyte counts less than 100/µl

*Although these regimens are broadly applicable, there are modifications that should be made under specified circumstances. Please refer to Treatment of Tuberculosis, MMWR 2003; 52(No. RR-11) for detailed information on TB treatment regimens.


A major cause of treatment failure and drug-resistant TB is nonadherence to treatment. Treatment failure and drug-resistant TB threaten the health of TB patients. These factors also pose serious public health risks because they can lead to prolonged infectiousness and the transmission of TB within the community.

One way to ensure that patients adhere to therapy is to use directly observed therapy (DOT). DOT means that a health care worker or another designated person watches the patient swallow each dose of TB medication. DOT should be considered for all patients because clinicians are often inaccurate in predicting which patients will adhere to medication on their own.

In many areas, patients are routinely given DOT. DOT has been shown to be cost-effective when intermittent regimens are used. Nearly all the treatment regimens for drug-susceptible TB can be given intermittently if they are directly observed; using intermittent regimens reduces the total number of doses a patient must take, as well as the total number of encounters with the health care provider or outreach worker. Furthermore, DOT can significantly reduce the frequency of acquired drug resistance and relapse.

Other measures commonly used to promote adherence:

  • Developing an individualized treatment plan for each patient
  • Working with outreach staff from the same cultural and linguistic background as the patient
  • Educating the patient about TB medication dosages and possible adverse reactions
  • Using incentives and enablers to remove barriers to adherence (e.g., transportation tokens and food vouchers)
  • Facilitating access to health and social services


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination -

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