Table 3.

First-line medications for cutaneous tuberculosis

MEDICATION	ADULT DOSING	CHILDREN DOSING
* TIW = three times weekly; BIW = three times weekly; CMP = complete metabolic panel; LFT = liver function tests; CBC = complete blood count
Isoniazid	5mg/kg daily, max 300mg 15mg/kg TIW, max 900mg	10–15mg/kg daily 20–30mg/kg intermittently
Rifampin	10mg/kg daily, max 600mg 10mg/kg TIW, max 600mg	10–20mg/kg daily or BIW
Pyrazinamide	20–25mg/kg daily, max 2g 30–40mg/kg TIW, max 3g	15–30mg/kg daily 40–50mg/kg BIW
Ethambutol	15–20mg/kg daily, max 1600mg 25–35mg/kg TIW, max 2400mg 40–50mg/kg BIW, max 4000mg	15–20mg/kg daily 50mg/kg BIW
MEDICATION	COMMON ADVERSE REACTIONS	COMMENTS	MONITORING
Isoniazid	Paresthesias and/or peripheral neuropathy, elevated liver transaminases, nausea and vomiting	Adjunctive pyridoxine (vitamin B6) 25–50mg daily Can follow with liver function tests or discontinue medication if causes hepatotoxicity Take medication on empty stomach or at bedtime	CMP at baseline; LFTs every month if patient is >35 years old, has a history of hepatic disease or alcohol or IV drug abuse, females in postpartum period; option opthalmological exam at baseline
Rifampin	Nausea and vomiting; anorexia; abdominal pain; diarrhea; orange and/or red-colored bodily fluids; flulike symptoms (fever, malaise, headache, myalgias, arthralgias); elevated liver transaminases	Take medication on empty stomach or at bedtime Reassurance Give antipyretics, nonsteroidal anti-inflammatory medications, rest Can follow with liver function tests or discontinue medication if causes hepatotoxicity	CBC, CMP at baseline; LFTs if hepatic impairment every 2–4 weeks
Pyrazinamide	Malaise, joint pain, rash, urticaria, photosensitivity, nausea, vomiting, anorexia, hyperuricemia, gout, elevated liver transaminases	Give aspirin or nonsteroidal anti-inflammatory Oral antihistamines, topical corticosteroids, emollients, sun protection Take medication at bedtime or treat with antinausea medications Can follow with uric acid levels and treat with appropriate agents or discontinue medication Can follow with liver function tests or discontinue medication if causes hepatotoxicity	CMP and uric acid at baseline, then periodically
Ethambutol	Blurred or changed vision, blindness, flu-like symptoms (fever, malaise, headache, myalgias, arthralgias), nausea, vomiting, anorexia, elevated liver transaminases, rash, pruritis	Optional ophthalmological examination; discontinuation of medication if necessary Give antipyretics, nonsteroidal anti-inflammatory medications, rest Take medication at bedtime or treat with antinausea medications Can follow with liver function tests or discontinue medication if causes hepatotoxicity Oral antihistamines, topical corticosteroids, emollients	CMP, CBC, optional ophthalmological examination at baseline, then periodically