Tuberculosis: 9. Treatment

Table 3: Options for treatment of tuberculosis in adults* Option Drug combination     and conditions     Frequency and duration of treatment Option 1     Initial phase† Isoniazid, rifampin and pyrazinamide; self-administered Daily for 8 wk Continuation phase   Isoniazid and rifampin; DOT Daily or intermittent (2 or 3 times/ wk) for 16 wk Option 2     Initial phase Isoniazid, rifampin, pyrazinamide, and streptomycin or ethambutol; DOT Daily for 2 wk Continuation phase Isoniazid, rifampin, pyrazinamide, and streptomycin or ethambutol; DOT 2 times/wk for 6 wk Secondary continuation phase Isoniazid and rifampin; DOT 2 times/wk for 16 wk Option 3     Initial phase Isoniazid, rifampin and pyrazinamide; self-administered 2 mo Continuation phase Isoniazid and rifampin 4–7 mo Note: DOT = directly observed therapy. For any therapeutic regimen, the physician should consult a tuberculosis medical expert if, after 3 months of treatment, the patient is symptomatic, or smear or culture yields positive results. *Adapted from the American Thoracic Society.18 †Where annual incidence of isoniazid resistance is greater than 4%, add ethambutol or streptomycin until susceptibility to isoniazid and rifampin is demonstrated.

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