Table 1.
Drug regimens for culture-positive pulmonary tuberculosis caused by drug-susceptible organisms.
| Initail Phase | Continual Phase | Range of total doses (minimum§¶ durations) |
Rating‡‡ (evidence)‡ | |||||
|---|---|---|---|---|---|---|---|---|
| Regimen | Drugs | Interval doses## (minimum durations) |
Regimen | Drugs | Interval doses§ (minimum durations) |
HIV− | HIV+ | |
| 1 | INH | Seven days per week for 56 doses (8 wk) or 5 d/wk for 40 doses (8 wk)** | 1a | INH/RIF | Seven days per week for 126 doses (18 wk) or 5 d/wk for 90 doses (18 wk)** | 182–130 (26 wk) | A (I) | A (II) |
| RIF | ||||||||
| PZA | ||||||||
| EMB | ||||||||
| 1b | INH/RIF | Twice weekly for 36 doses (18 wk) | 92–72 (26 wk) | A (I) | A (II)‡‡ | |||
| 1c§§ | INH/RPT | Once weekly for 18 doses (18 wk) | 74–56 (26 wk) | B (I) | E (I) | |||
| 2 | INH | Seven days per week for 14 doses (2 wk), then twice weekly for 12 doses (6 wk) or 5 d/wk for 10 doses (2 wk)** then twice weekly for 12 doses (6 wk) | 2a | INH/RIF | Twice weekly for 36 doses (18 wk) | 62–58 (26 wk) | A (II) | B (II)‡‡ |
| RIF | 2b§§ | INH/RIF | Once weekly for 18 doses (18 wk) | 44–40 (26 wk) | B (I) | E (I) | ||
| PZA | ||||||||
| EMB | ||||||||
| 3 | INH | Three times weekly for 24 doses (8 wk) | 3a | INH/RIF | Three times weekly for 54 doses (18 wk) | 78 (26 wk) | B (I) | B (II) |
| RIF | ||||||||
| PZA | ||||||||
| EMB | ||||||||
| 4 | INH | Seven days per week for 56 doses (8 wk) or 5 d/wk for 40 doses for (8 wk)** | 4a | INH/RIF | Seven days per week for 217 doses (31 wk) or 5 d/wk for 155 doses (31 wk)** | 273–195 (39 wk) | C (I) | C (II) |
| RIF | ||||||||
| EMB | ||||||||
| 4b | INH/RIF | Twice weekly for 62 doses (31 wk) | 118–102 (39 wk) | C (I) | C (II) | |||
EMB = Ethambutol: INH = isoniazid: PZA = pyrazinamide: RIF = rifampin: RPT = rifapentine.
Definitions of evidence ratings: A = preferred, B = acceptable alternative; C = offer when A and B cannot be given: E = should never be given
Definition of evidence ratings: I = randomized clinical trial: ll = data from clinical trials that were not randomized or conducted in other populations: lll = expert opinions.
When DOT is used, drugs may be given 5 days/week and the necessary number of doses adjusted accordingly. Although there are no studies that compare five with seven daily doses, extensive experience indicates that would be an effective practice.
Patients with cavitation on initial chest radiograph and positive cultures at completion of 2 months of therapy should receive a 7-month (31 week; either 217 doses [daily] or 62 doses (twice weekly) continuation phase.
Five-day-a-week administration is always given by DOT. Rating for 5 day/week regimens is A Ill.
Not recommended for HIV-infected patients with CD4+ cell counts < 100 cells/µl.
Options 1c and 2b should be used only in HIV-negative patients who have negative sputum smears at the time of completion of 2 months of therapy and who do not have cavitation on initial chest radiograph (see text). For patients started on this regimen and found to have a possible culture from the 2-month specimen, treatment should be extended an extra 3 months.