Recommendations for Treatment of Active Tuberculosis

RECOMMENDATIONS FOR TREATMENT OF ACTIVE TUBERCULOSIS

The most commonly used regimen for drug-susceptible tuberculosis consists of isoniazid, rifampin, and pyrazi-namide daily for 2 months, followed by isoniazid and ri-fampin daily or two to three times a week for 4 months. If isoniazid resistance is suspected, ethambutol or strep-tomycin should be added to the regimen until the sus-ceptibility of the mycobacterium is determined. Thisregimen will provide at least two drugs to which the M. tuberculosis isolate is susceptible in more than 95% of patients in the United States.

Alternative regimens include isoniazid, rifampin, pyrazinamide, and either streptomycin or ethambutol for 2 weeks followed biweekly with the same regimen for 6 weeks, and subsequently with biweekly adminis-tration of isoniazid and rifampin for 16 weeks. In HIV-infected patients the treatment should be prolonged 9 to 12 months or sometimes even longer if the response is slow. Treatment of tuberculosis is more challenging in an HIV-infected population taking highly active anti-retroviral therapy because of drug interactions.