Table 2.
Treatment of active tuberculosis.
| Treatment scheme | Survey findings | WHO module 5 (2022) | ERS/ECDC statement (2017) | IJTLD clinical standards (2023) |
|---|---|---|---|---|
| Standard treatment regimen | 97% use 2HRZ(E)/4HR regimen for presumed drug-susceptible TB | 2HRZ(E)/4HR regimen used when criteria for the 4-month regimen are not met | 2HRZE/4HR regimen for drug-susceptible TB | 2HRZ(E)/4HR regimen used when criteria for the 4-month regimen are not met |
| Shortened regimens (4-month) | 46% use 4-month regimen for non-severe TB (Turkova criteria) | 4-month regimen for eligible children with non-severe TB (Turkova criteria) | NA | 4-month regimen for eligible children with non-severe TB (Turkova criteria) |
| TB meningitis | 67% use 2RHZE/10HR; 33% add or replaced ethambutol by fluoroquinolone | 2RHZE/10RH recommended; 6-month RHZEth intensive regimen may be used in selected children without drug resistance, excluding HIV-positive patients | NA | 2RHZE/10RH recommended; 6-month RHZEth intensive regimen may be used in selected children without drug resistance, excluding HIV-positive patients; ethambutol might be replaced by fluoroquinolones |
| Adjunctive cortico-steroids | Corticosteroids used by 94%; most commonly for 4 weeks | Corticosteroids tapered over 6–8 weeks recommended | Refer to WHO | Corticosteroids given for 4 weeks then tapered over 2–4 weeks recommended |
| Pyridoxine supplementation | Routinely prescribed with isoniazid in 47%; selectively in malnutrition, exclusive breastfed, or comorbidities | Recommended for all pregnant/breastfeeding individuals, those with HIV, malnutrition, alcohol use, diabetes, chronic liver or kidney disease | NA | Recommended for children with HIV or malnourished, all infants and adolescents (especially pregnant), and those receiving high-dose isoniazid |
| Management of MDR-TB | Use of fluoroquinolones as first-line for suspected isoniazid-resistant TB in 49% | MDR-TB managed according to DST; 6REZLfx for confirmed rifampicin-susceptible, isoniazid-resistant TB | MDR-TB managed by specialist center based on DST; Minimum of 5 anti-TB drug for at least 20 months (including 8 months intensive phase) | NA |
DST, drug susceptibility testing; H, isoniazid; R, rifampicin; Z, pyrazinamide; E, ethambutol; RHZE, combination of rifampicin, isoniazid, pyrazinamide, and ethambutol; 2HRZ(E)/4HR, standard 6-month first-line TB regimen (2-month intensive phase, 4-month continuation phase); 2RHZE/10HR, 12-month regimen including 2 months of rifampicin, isoniazid, pyrazinamide and ethambutol followed by 10 months of rifampicin and isoniazid; 6REZLfx, a 6-month regimen with rifampicin, ethambutol, pyrazinamide and levofloxacin; MDR-TB, multidrug-resistant tuberculosis; NA, not applicable.