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Table 5. First-Line Anti-TB Medications

Drug Route Dose in mg/kg (Maximum Dose) Adverse
Reactions
Monitoring Comments
Daily 2 Times/Week1 3 Times/Week1
Children Adults Children Adults Children Adults
INH PO or IM 10-20 (300 mg) 5 (300 mg) 20-40 (900 mg) 15 (900 mg) 20-40 (900 mg) 15 (900 mg) Rash
Hepatic enzyme elevation
Hepatitis
Peripheral neuropat Mild CNS effects
Drug interactions resulting in increased phenytoin (Dilantin) or disulfiram (Antabuse) levels
Baseline measurements of hepatic enzymes for adults.
Repeat measurements if
  • baseline results are abnormal
  • patient is at high risk for adverse reactions
  • patient has symptoms of adverse reactions
  • Hepatitis risk increases with age and alcohol consumption.

    Pyridoxine (Vitamin B6 ) may prevent peripheral neuropathy and CNS effects

    10-15 mg/ kg should be used for children when treating for latent TB infection

    RIF PO or IV 10-20(600 mg) 10(600 mg) 10-20(600 mg) 10(600 mg) 10-20(600 mg) 10(600 mg) GI upset
    Drug interactions
    Hepatitis
    Bleeding problems
    Flu-like symptoms
    Rash
    Renal failure
    Fever
    Baseline measurements of CBC, platelets, and hepatic enzymes.

    Repeat measurements if

  • base s are abnormal 
  • patient has symptoms of adverse reactions
  • Significant interactions with methadone, birth control hormones, and many other drugs

     Contraindicated or should be used with caution when administ Is and NNRTIs. 

    C fluids orange. 

    May permanently discolor soft contact lenses

    RFB2 PO or IV 10-20 (300 mg)

    or

    (150 mg)3

    or

    (450 mg)4

    5 (300 mg)

    or

    (150 mg)3< or 

    (450 mg)4

    10-20 (300 mg)

    or

    10-20 (300 mg)

    or

    (450 mg)4

    5 (300 mg)

    or

    53 (300 mg)

    or

    (450 mg)4

    Not Known Not Known Rash
    Hepatitis
    Fever
    Thrombocytopenia
    With increased levels of RFB:
    • Severe arthralgias
    • Uveitis
    • Leukopenia
    Baseline measurements of CBC, plate epatic enzymes 

    Repeat measurements if

  • baseline results are abnormal
  • patient has symptoms of adverse reactions Use adjusted daily dose of RFB3 , and monitor for decreased antiretroviral activity and for RFB toxicity if RFB taken concurrently with PIs or NNRTIs
  • RFB is contraindicated in patients taking ritonavir or delavirdine

    Reduces levels of many drugs (e. g., PIs, NNRTIs, methadone, dapsone, ketoconazole, hormo eptives, etc). 

    C fluids orange. 

    May permanently discolor soft contact lenses

    PZA PO 15-20 (2 g) 15-30 (2 g) 50-70 (4 g) 50-70 (4 g) 50-70 (3 g) 50-70 (3 g) Hepatitis
    Rash
    GI upset
    Joint aches
    Hyperuricemia
    Gout (rare)
    Baseline measurements of uric acid and hepatic enzymes.

    Repeat measurements if

  • ba s are abnormal 
  • patient has symptoms of adverse reactions
  • Treat hyperuricemia only has symptoms. 

    May make glucose control more difficult in diabetics

    EMB5 PO 15-25 15-25 50 50 25-30 25-30 Optic neuritis
    Rash
    Baseline and monthly tests of visual acuity and color vision Not recommended for children too young to be monitored for changes in vision unless T rug resistant.

    Optic neuritis may be unilateral, check each eye separately

    SM IM or IV 20-40 (1 g) 15 (1 g) 25-30 (1.5 g) 25-30 (1.5 g) 25-30 (1.5 g) 25-30 (1.5 g) Ototoxicity (hearing loss orvestibular dysfunction)
    Renal toxicity
    Baseline and repeat as needed of hearing and renal function tests Ultrasound and warm compresses to injection site may reduce pain.

    Avoid or reduce dose in adults ³60 years old

    Footnotes

    INH = isoniazid, RIF = rifampin, RFB = rifabutin, PZA = pyrazinamide, EMB = ethambutol, SM = streptomycin, PIs = Protease Inhibitors, NNRTIs = nonnucleoside reverse transcriptase inhibitors, PO = by mouth, IM = intramuscular, IV = intravenous, CNS = central nervous system

    Notes: Consult product insert for detailed information. Children £12 years old. Adjust weight-based dosages as weight changes.

    1. All intermittent dosing should be used with directly observed therapy.
    2. The concurrent administration of rifabutin is contraindicated with hard-gel saquinavir and delavirdine. An alternative is the use of rifabutin with indinavir, nelfinavir, amprenavir, ritonavir, efavirenz, and possibly soft- gel saquinavir and nevirapine. Caution is advised when using rifabutin with soft-gel saquinavir and nevirapine, because data regarding the use of rifabutin with soft- gel saquinavir and nevirapine are limited.
    3. If nelfinavir, indinavir, amprenavir, or ritonavir is administered with RFB, blood concentrations of the PIs decrease. Thus, when RFB is used concurrently with any of these drugs, the daily dose of RFB is reduced from 300 mg to 150 mg when used with nelfinavir, indinavir, or amprenavir; and to 150 mg two or three times a week when used with ritonavir.
    4. If efavirenz is administered with RFB, blood concentrations of RFB decrease. Thus, when RFB is used with efavirenz, the daily dose of RFB should be increased from 300 mg to 450 mg or 600 mg.
    5. No maximum dosages for EMB but in obese patients dosage should be calculated on lean body weight.

     


    Released October 2008
    Centers for Disease Control and Prevention
    National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
    Division of Tuberculosis Elimination - http://www.cdc.gov/tb

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