Table 1.
Summary of the first and second line anti-tuberculosis medications with recommended doses and drug-drug interactions* [60–63]
| Drug | Dose Recommended | Drug-drug interactions with antiretrovirals |
|---|---|---|
| Group 1 | ||
| Isoniazid | 7–15 mg/kg once daily | None |
| Rifampicin | 10–20 mg/kg once daily | Coadministration reduces concentrations ofa NNRTIs, bPIs, integrase inhibitors |
| Pyrazinamide | 30–40 mg/kg once daily | None |
| Ethambutol | 15–25 mg/kg once daily | None |
| Rifabutin | 10–20 mg/kg/day (Max Dose 300 mg/day) | Boosted PI: increase rifabutin levels and rifabutin dose reduction is needed NNRTI: Efavirence reduces the concentration of rifabutin, increasing the rifabutin dose is recommended in adults Nevirapine dose adjustment is not needed for rifabutin |
| Group 2 | ||
| Kanamycin | 15–30 mg/kg once daily, max 1 g | |
| Amikacin | 15–22.5 mg/kg once daily, max 1 g | |
| Capreomycin | 15–30 mg/kg once daily, max 1 g | |
| Streptomycin | 20–40 mg/kg once daily, max 1 g | |
| Group 3 | ||
| Ofloxacin | 15–20 mg/kg once daily, max 800 mg | |
| Levofloxacin | (15–20 mg/kg once daily)†, 7.5–10 mg/kg once daily, max 750 mg | |
| Moxifloxacin | 7.5–10 mg/kg once daily, max 400 mg | Moxifloxacin concentration could be reduced by ritonavir, though limited data; buffered didanosine may reduce oral absorption of all fluoroquinolones |
| Group 4 | ||
| Ethionamide/Prothionamide | 15–20 mg/kg once daily, max 1 g | Possible, unknown |
| Cycloserine/Terizidone | 10–20 mg/kg once or twice daily, max 1 g | Unlikely, unknown |
| Para-aminosalicylic acid (PAS) | 150 mg/kg granules daily in 2–3 divided doses, max 12 g | Co-administration with efavirenz may reduc PAS AUC by 50% |
| Group 5 | ||
| Linezolid | (10 mg/kg twice daily, once daily for >10 years of age)c | Unlikely |
| Clofazimine | (3–5 mg/kg once daily)c | Unknown; may be a weak CYP3A4 inhibitor |
| Amoxicillin-clavulanic acid, Meropenem-clavulanic acid, and Imipenem/cilastin | As for bacterial infections | Unlikely |
| Thiacetazone | 5–8 mg/kg once daily | Contraindicated in HIV-infected individuals |
| High-dose isoniazid | 15–20 mg/kg once daily | None |
| Clarithromycin | 7.5–15 mg/kg twice daily | Clarithomycin levels increase with boosted atazanavir and lopinavir with increased risk of toxisity. Clarithomycin levels are decreased by efavirence, nevirapine and etravirine Azithromycinn is prefered |
| Azithromycin | 10 mg/kg once daily | Prefered macrolide but limited activity and caution required |
† Indicates bracketed recommended by some experts, but differs from formal WHO guideline
a NNRTI Non-nucleoside reverse transcriptase inhibitor, b PI Protease inhibitor
cNo formal paediatric dose recommended in WHO guidelines, so presented dose based on experience and expert opinion