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Table 6. Second-Line Anti-TB Medications, 2000

Drug Route Daily Dose1 (Maximum Dose) Adverse reactions Monitoring Comments
Capreomycin IM or IV 15-30 mg/kg (1 g) Toxicity
  • auditory
  • vestibular
  • renal
Assess vestibular function and hearing function prior to initiation of therapy and at regular intervals during treatment

Measure blood urea nitrogen and creatinine throughout treatment

After bacteriologic conversion, dosage may be reduced to 2-3 times per week. 

Safety and effectiveness in children have not been established.

Kanamycin IM or IV 15-30 mg/kg (1 g) Toxicity
  • auditory
  • vestibular
  • renal
Assess vestibular function and hearing function prior to initiation of therapy and at regular intervals during treatment

Measure blood urea nitrogen and creatinine throughout treatment

After bacteriologic conversion, dosage may be reduced to 2-3 times per week. 

Not approved by FDA for TB treatment

Amikacin IM or IV 15-30 mg/kg (1 g) Toxicity
  • auditory
  • vestibular
  • renal
Chemical imbalance
Dizziness
Assess vestibular function and hearing function prior to initiation of therapy and at regular intervals during treatment

Measure renal function and serum drug levels

After bacteriologic conversion, dosage may be reduced to 2-3 times per week. 

Not approved by FDA for TB treatment

Ethionamide PO 15-20 mg/kg (1 g) GI upset
Hepatotoxicity
Hypersensitivity
Metallic taste
Measure hepatic enzymes Start with low dosage and increase as tolerated

May cause hypothyroid condition, especially if used with PAS

Para-aminosalicylic acid (PAS) PO 150 mg/ kg (16 g) GI upset
Hypersensitivity
Hepatotoxicity
Sodium load
Measure hepatic enzymes.

Assess volume status

Start with low dosage and increase as tolerated

Monitor cardiac patients for sodium load

May cause hypothyroid condition, especially if used with ethionamide

Cycloserine PO 15-20 mg/ kg (1 g) Psychosis
Convulsions, Depression
Headaches
Rash
Drug interactions
Assess mental status.

Measure serum drug levels

Start with low dosage and increase as tolerated. 

Pyridoxine may decrease CNS effects

Ciprofloxacin PO 750-1500 mg/ day GI upset
Dizziness
Hypersensitivity
Drug interactions
Headaches
Restlessness
Drug interactions Not approved by the FDA for TB treatment.

 Should not be used in children 

Avoid coadministration within 2 hours of:

  • antacids
  • iron
  • zinc
  • sucralfate
Ofloxacin PO 600-800 mg/ day GI upset
Dizziness
Hypersensitivity
Drug interactions
Headaches
Restlessness
Drug interactions Not approved by the FDA for TB treatment.

 Should not be used in children 

Avoid coadministration within 2 hours of:

  • antacids
  • iron
  • zinc
  • sucralfate
Levofloxacin PO 500 mg/ day GI upset
Dizziness
Hypersensitivity
Drug interactions
Headaches
Restlessness
Drug interactions Not approved by the FDA for TB treatment

Should not be used in children 

Avoid coadministration within 2 hours of:

  • antacids
  • iron
  • zinc
  • sucralfate
Clofazimine PO 100-300 mg/ day GI upset
Discoloration of skin
Severe abdominal pain and organ damage due to crystal deposition
Drug interactions Not approved by FDA for TB treatment 

Avoid sunlight 

Consider dosing at mealtime 

Efficacy unproven

Footnotes

PO = by mouth, IM = intramuscular, IV = intravenous

Consult product insert for detailed information

  1. Adjust weight- based dosages as weight changes

Notes: Doses for children the same as for adults. Use these drugs only in consultation with a clinician experienced in the management of drug-resistant TB.

 


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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