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Table 3. Regimen Options for Treatment of TB Disease, 2000

Option Indication Total Duration (weeks) Induction Phase Continuation Phase Comments
Drugs Interval and Duration Drugs Interval and Duration
1 Pulmonary and extrapulmonary TB in adults and children 24 INH, RIF, PZA4, EMB or SM4 Daily for 8 weeks INH, RIF Daily or 2 or 3 times/week1 for 16 weeks2 EMB or SM should be continued until susceptibility to INH and RIF is demonstrated.

In areas where primary INH resistance <4%, EMB or SM may not be necessary for patients with no individual risk factors for drug resistance.

Intermittent regimen should be directly observed.

2 Pulmonary and extrapulmonary TB in adults and children 24 INH, RIF, PZA4, EMB or SM4 Daily for 2 weeks and then 2 times/week1 for 6 weeks INH, RIF 2 times/week1 for 16 weeks2 Regimen should be directly observed.

After the 8 week induction phase, continue EMB or SM until susceptibility to INH and RIF is demonstrated, unless drug resistance is unlikely.

3 Pulmonary and extrapulmonary TB in adults and children 24 INH, RIF, PZA4, EMB or SM4 3 times/week1 for 24 weeks2 Regimen should be directly observed.

Continue all four drugs for 6 months3.

This regimen has been shown to be effective for INH-resistant TB.

4 Smear- and culture- negative pulmonary TB in adults 16 INH, RIF, PZA4, EMB or SM4 Follow option 1, 2, or 3 for 8 weeks INH, RIF, PZA4, EMB or SM4 Daily or 2 or 3 times/week1 for 8 weeks Continue all four drugs for 4 months.

If drug resistance is unlikely (primary INH resistance <4% and patient has no individual risk factors for drug resistance), EMB or SM may not be necessary and PZA may be discontinued after 2 months.

5 Pulmonary and extrapulmonary TB in adults and children when PZA is contraindicated 36 INH, RIF, EMB or SM4 Daily for 4-8 weeks INH, RIF Daily or 2 times/ week1 for 28- 32 weeks2 EMB or SM should be continued until susceptibility to INH and RIF is demonstrated.

In areas where primary INH resistance <4%, EMB or SM may not be necessary for patients with no individual risk factors for drug resistance.

Footnotes

INH = isoniazid, RIF = rifampin, PZA = pyrazinamide, EMB = ethambutol, SM = streptomycin

Note: For all patients, if susceptibility results show resistance to any of the first-line drugs or if the patient remains symptomatic or smear or culture positive after 3 months, consult a TB medical expert.

  1. All intermittent dosing should be used with directly observed therapy
  2. For infants and children with miliary TB, bone and joint TB, or TB meningitis, treatment should last at least 12 months. For adults with these forms of extrapulmonary TB, response to therapy should be monitored closely. If response is slow or suboptimal, treatment may be prolonged as judged on a case- by- case basis.
  3. There is some evidence that SM may be discontinued after 4 months if the isolate is susceptible to all drugs.
  4. Avoid SM and PZA for pregnant women because of the risk of adverse effects to the fetus.

 


Released October 2008
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