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Treatment for TB Disease

TB disease can be treated by taking several drugs for 6 to 9 months. It is very important that people who have TB disease finish the medicine, taking 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 bacteria that are still alive may become resistant to those drugs. TB that is resistant to drugs is harder and more expensive to treat.

Recommended Regimens

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 include:

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

Listed below are the basic regimens; refer to Treatment of Tuberculosis for all options for the treatment of drug-susceptible TB disease.

Table 1. Basic TB Disease Treatment Regimens

Preferred Regimen Alternative Regimen Alternative Regimen

Initial Phase
Daily INH, RIF, PZA, and EMB* for 56 doses (8 weeks)

Initial Phase
Daily INH, RIF, PZA, and EMB* for 14 doses (2 weeks), then twice weekly for 12 doses (6 weeks)

Initial Phase
Thrice-weekly INH, RIF, PZA, and EMB* for 24 doses (8 weeks)

Continuation Phase
Daily INH and RIF for 126 doses (18 weeks)
or
Twice-weekly INH and RIF for 36 doses (18 weeks)

Continuation Phase
Twice-weekly INH and RIF for 36 doses (18 weeks)

Continuation Phase
Thrice-weekly INH and RIF for 54 doses (18 weeks)

*EMB can be discontinued if drug susceptibility studies demonstrate susceptibility to first-line drugs.

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 initial 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 initial 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 initial phase is positive.

Treatment Completion

Treatment completion is determined by the number of doses ingested over a given period of time. Although basic TB regimens are broadly applicable, there are modifications that should be made under special circumstances (e.g., HIV infection, drug resistance, pregnancy, or treatment of children). 

Treatment for Drug-resistant Tuberculosis

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).

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.

Drug resistance is proven by drug-susceptibility testing. However, since this testing can take weeks, treatment should be started with an empirical treatment regimen based on expert advice as soon as drug-resistant TB disease is suspected. When the testing results are known, the treatment regimen should be adjusted according to the results. Patients should be monitored closely throughout treatment. Directly observed therapy (DOT) always should be used in the treatment of drug-resistant TB to ensure adherence.

 
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