Table 3.

Doses^a of Antituberculosis Drugs for Adults and Children^b

Drug	Preparation	Population	Daily	Once-Weekly	Twice-Weekly	Thrice-Weekly
First-line drugs
Isoniazid	Tablets (50 mg, 100 mg, 300 mg); elixir (50 mg/5 mL); aqueous solution (100 mg/mL) for intravenous or intramuscular injection. Note: Pyridoxine (vitamin B6), 25–50 mg/day, is given with INH to all persons at risk of neuropathy (eg, pregnant women; breastfeeding infants; persons with HIV; patients with diabetes, alcoholism, malnutrition, or chronic renal failure; or patients with advanced age). For patients with peripheral neuropathy, experts recommend increasing pyridoxine dose to 100 mg/d.	Adults	5 mg/kg (typically 300 mg)	15 mg/kg (typically 900 mg)	15 mg/kg (typically 900 mg)	15 mg/kg (typically 900 mg)
		Children	10–15 mg/kg	…	20–30 mg/kg	…b
Rifampin	Capsule (150 mg, 300 mg). Powder may be suspended for oral administration. Aqueous solution for intravenous injection.	Adultsc	10 mg/kg (typically 600 mg)	…	10 mg/kg (typically 600 mg)	10 mg/kg (typically 600 mg)
		Children	10–20 mg/kg	…	10–20 mg/kg	…b
Rifabutin	Capsule (150 mg)	Adultsd	5 mg/kg (typically 300 mg)	…	Not recommended	Not recommended
		Children	Appropriate dosing for children is unknown. Estimated at 5 mg/kg.
Rifapentine	Tablet (150 mg film coated)	Adults		10–20 mg/kge	…	…
		Children	Active tuberculosis: for children ≥12 y of age, same dosing as for adults, administered once weekly. Rifapentine is not FDA-approved for treatment of active tuberculosis in children <12 y of age.
Pyrazinamide	Tablet (500 mg scored)	Adults	See Table 10	…	See Table 10	See Table 10
		Children	35 (30–40) mg/kg	…	50 mg/kg	…b
Ethambutol	Tablet (100 mg; 400 mg)	Adults	See Table 11	…	See Table 11	See Table 11
		Childrenf	20 (15–25) mg/kg	…	50 mg/kg	…b
Second-line drugs
Cycloserine	Capsule (250 mg)	Adultsg	10–15 mg/kg total (usually 250–500 mg once or twice daily)	There are inadequate data to support intermittent administration.
		Children	15–20 mg/kg total (divided 1–2 times daily)
Ethionamide	Tablet (250 mg)	Adultsh	15–20 mg/kg total (usually 250–500 mg once or twice daily)	There are inadequate data to support intermittent administration.
		Children	15–20 mg/kg total (divided 1–2 times daily)
Streptomycin	Aqueous solution (1 g vials) for IM or IV administration.	Adults	15 mg/kg daily. Some clinicians prefer 25 mg/kg 3 times weekly. Patients with decreased renal function may require the 15 mg/kg dose to be given only 3 times weekly to allow for drug clearance.
		Children	15–20 mg/kg [427]	…	25–30 mg/kgi	…
Amikacin/kanamycin	Aqueous solution (500 mg and 1 g vials) for IM or IV administration.	Adults	15 mg/kg daily. Some clinicians prefer 25 mg/kg 3 times weekly. Patients with decreased renal function, including older patients, may require the 15 mg/kg dose to be given only 3 times weekly to allow for drug clearance.
		Children	15–20 mg/kg [427]	…	25–30 mg/kgi	…
Capreomycin	Aqueous solution (1 g vials) for IM or IV administration.	Adults	15 mg/kg daily. Some clinicians prefer 25 mg/kg 3 times weekly. Patients with decreased renal function, including older patients, may require the 15 mg/kg dose to be given only 3 times weekly to allow for drug clearance.
		Children	15–20 mg/kg [427]	…	25–30 mg/kgi	…
Para-amino salicylic acid	Granules (4 g packets) can be mixed in and ingested with soft food (granules should not be chewed). Tablets (500 mg) are still available in some countries, but not in the United States. A solution for IV administration is available in Europe.	Adults	8–12 g total (usually 4000 mg 2–3 times daily)	There are inadequate data to support intermittent administration.
		Children	200–300 mg/kg total (usually divided 100 mg/kg given 2 to 3 times daily)
Levofloxacin	Tablets (250 mg, 500 mg, 750 mg); aqueous solution (500 mg vials) for IV injection.	Adults	500–1000 mg daily	There are inadequate data to support intermittent administration.
		Children	The optimal dose is not known, but clinical data suggest 15–20 mg/kg [427]
Moxifloxacin	Tablets (400 mg); aqueous solution (400 mg/250 mL) for IV injection	Adults	400 mg daily	There are inadequate data to support intermittent administration.j
		Children	The optimal dose is not known. Some experts use 10 mg/kg daily dosing, though lack of formulations makes such titration challenging. Aiming for serum concentrations of 3–5 µL/mL 2 h postdose is proposed by experts as a reasonable target.

Abbreviations: FDA, US Food and Drug Administration; HIV, human immunodeficiency virus; IM, intramuscular; INH, isoniazid; IV, intravenous.

^a Dosing based on actual weight is acceptable in patients who are not obese. For obese patients (>20% above ideal body weight [IBW]), dosing based on IBW may be preferred for initial doses. Some clinicians prefer a modified IBW (IBW + [0.40 × (actual weight – IBW)]) as is done for initial aminoglycoside doses. Because tuberculosis drug dosing for obese patients has not been established, therapeutic drug monitoring may be considered for such patients.

^b For purposes of this document, adult dosing begins at age 15 years or at a weight of >40 kg in younger children. The optimal doses for thrice-weekly therapy in children and adolescents have not been established. Some experts use in adolescents the same doses as recommended for adults, and for younger children the same doses as recommended for twice-weekly therapy.

^c Higher doses of rifampin, currently as high as 35 mg/kg, are being studied in clinical trials.

^d Rifabutin dose may need to be adjusted when there is concomitant use of protease inhibitors or nonnucleoside reverse transcriptase inhibitors.

^e TBTC Study 22 used rifapentine (RPT) dosage of 10 mg/kg in the continuation phase of treatment for active disease [9]. However, RIFAQUIN and PREVENT TB safely used higher dosages of RPT, administered once weekly [164, 210]. Daily doses of 1200 mg RPT are being studied in clinical trials for active tuberculosis disease.

^f As an approach to avoiding ethambutol (EMB) ocular toxicity, some clinicians use a 3-drug regimen (INH, rifampin, and pyrazinamide) in the initial 2 months of treatment for children who are HIV-uninfected, have no prior tuberculosis treatment history, are living in an area of low prevalence of drug-resistant tuberculosis, and have no exposure to an individual from an area of high prevalence of drug-resistant tuberculosis. However, because the prevalence of and risk for drug-resistant tuberculosis can be difficult to ascertain, the American Academy of Pediatrics and most experts include EMB as part of the intensive-phase regimen for children with tuberculosis.

^g Clinicians experienced with using cycloserine suggest starting with 250 mg once daily and gradually increasing as tolerated. Serum concentrations often are useful in determining the appropriate dose for a given patient. Few patients tolerate 500 mg twice daily.

^h Ethionamide can be given at bedtime or with a main meal in an attempt to reduce nausea. Clinicians experienced with using ethionamide suggest starting with 250 mg once daily and gradually increasing as tolerated. Serum concentrations may be useful in determining the appropriate dose for a given patient. Few patients tolerate 500 mg twice daily.

ⁱ Modified from adult intermittent dose of 25 mg/kg, and accounting for larger total body water content and faster clearance of injectable drugs in most children. Dosing can be guided by serum concentrations.

^j RIFAQUIN trial studied a 6-month regimen. Daily isoniazid was replaced by daily moxifloxacin 400 mg for the first 2 months, followed by once-weekly doses of moxifloxacin 400 mg and RPT 1200 mg for the remaining 4 months. Two hundred twelve patients were studied (each dose of RPT was preceded by a meal of 2 hard-boiled eggs and bread). This regimen was shown to be noninferior to a standard daily administered 6-month regimen [164].