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Treatment for TB Disease

When TB bacteria become active (multiplying in the body) and the immune system can’t stop the bacteria from growing, this is called TB disease. TB disease will make a person sick. People with TB disease may spread the bacteria to people with whom they spend many hours.

It is very important that people who have TB disease are treated, finish the medicine, and take the drugs exactly as prescribed. If they stop taking the drugs too soon, they can become sick again; if they do not take the drugs correctly, the TB bacteria that are still alive may become resistant to those drugs. TB that is resistant to drugs is harder and more expensive to treat.

TB disease can be treated by taking several drugs for 6 to 9 months.  There are 10 drugs currently approved by the U.S. Food and Drug Administration (FDA) for treating TB. Of the approved drugs, the first-line anti-TB agents that form the core of treatment regimens are:

  • isoniazid (INH)
  • rifampin (RIF)
  • ethambutol (EMB)
  • pyrazinamide (PZA)

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TB Regimens for Drug-Susceptible TB

Regimens for treating TB disease have an intensive phase of 2 months, followed by a continuation phase of either 4 or 7 months (total of 6 to 9 months for treatment).

Drug Susceptible TB Disease Treatment Regimens

Preferred Regimen
Intensive Phase
Daily INH, RIF, PZA, and EMB* for 40-56 doses** (8 weeks)
Continuation Phase
Daily INH and RIF for 90-126 doses** (18 weeks)
or
three-times-weekly INH and RIF for 54 doses (18 weeks)
Alternative Regimen
Intensive Phase
Daily INH, RIF, PZA, and EMB* for 14 doses (2 weeks), then three-times-weekly for 18 doses (6 weeks)
Continuation Phase
Three-times-weekly INH and RIF for 54 doses (18 weeks)
Alternative Regimen
Intensive Phase
Three-times-weekly INH, RIF, PZA, and EMB* for 24 doses (8 weeks)
Continuation Phase
Three-times-weekly INH and RIF for 54 doses (18 weeks)

* EMB can be discontinued if drug susceptibility studies demonstrate susceptibility to first-line drugs.
** Guidelines allow dosing 5 or 7 days-a-week; 5 days-a-week administration by DOT is an acceptable alternative to 7 days a-week administration.

Note: 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 intensive phase of treatment.  


Continuation Phase of Treatment

The continuation phase of treatment is given for either 4 or 7 months. The 4-month continuation phase should be used in the large majority of patients. The 7-month continuation phase is recommended only for three groups:

  • Patients with cavitary pulmonary tuberculosis caused by drug-susceptible organisms and whose sputum culture obtained at the time of completion of 2 months of treatment is positive;
  • patients whose intensive phase of treatment did not include PZA; and
  • patients being treated with once weekly INH and rifapentine and whose sputum culture obtained at the time of completion of the intensive phase is positive.


Treatment Completion

Treatment completion is determined by the number of doses ingested over a given period of time.

Treatment for Drug-Resistant TB

Drug-resistant TB is caused by TB bacteria that are resistant to at least one first-line anti-TB drug. Multidrug-resistant TB (MDR TB) is resistant to more than one anti-TB drug and at least isoniazid (INH) and rifampin (RIF).

Extensively drug-resistant TB (XDR TB) is a rare type of MDR TB that is resistant to isoniazid and rifampin, plus any fluoroquinolone and at least one of three injectable second-line drugs (i.e., amikacin, kanamycin, or capreomycin).

Treating and curing drug-resistant TB is complicated. Inappropriate management can have life-threatening results. Drug-resistant TB should be managed by or in close consultation with an expert in the disease.

For more information on drug-resistant TB, visit the Drug-Resistant TB Page

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