Table 4.
Daily treatment regimens for “new” adult patients presumed or known to have drug-susceptible miliary TB.
| Variable | Guideline (reference) |
||
|---|---|---|---|
| ATS-CDC-IDSA (157) | NICE (158) | WHO (156) | |
| Year of publication | 2003 | 2006 | 2010 |
| Intensive phase | RHZE for 2 months | RHZE for 2 months | RHZE for 2 months |
| Continuation phase | RH for 4 months | RH for 4 months | RH for 4 months* |
| If TBM is present, RH for 7–10 months | If TBM is present, RH for 10 months | If TBM is present, RH for 7–10 months | |
| If bone and joint TB is present, RH for 7 months | |||
| Total duration | 6 months | 6 months | 6 months |
| If TBM is present, 9–12 months | If TBM is present, 12 months | If TBM is present, 9–12 months | |
| If bone and joint TB is present, 9 months | |||
| Glucocorticoids | Not routinely recommended for miliary TB. Strongly recommended if TBM, TB pericarditis are present. | Not routinely recommended for miliary TB. | Not routinely recommended for miliary TB. |
| For TB pericarditis, glucocorticoid treatment is recommended for 11 weeks. | Recommended if TBM, TB pericarditis are present. | Recommended for TBM and TB pericarditis | |
| Daily treatment with oral prednisone (60 mg/day, or the equivalent dose of prednisolone) is given for 4 weeks, followed by 30 mg/day for 4 weeks, 15 mg/day for 2 weeks, and finally 5 mg/day for week 11 (final week). | For TB pericarditis, glucocorticoid equivalent to prednisolone 60 mg/day, gradually withdrawn after 2–3 weeks of initiation is recommended. | ||
| For TBM, glucorticoid treatment is recommended for 6 weeks. Daily treatment with oral dexamethasone, 12 mg/day, is given for 3 weeks followed by 6 mg/day for the next 3 weeks. Glucocorticoid treatment may be useful for treating respiratory failure (expert opinion) | For TBM, glucocorticoid equivalent to prednisolone 20–40 mg if on rifampicin, otherwise 10–20 mg gradually withdrawn after 2–3 weeks of initiation is recommended. | ||
ATS = American Thoracic Society; CDC = Centers for Disease Control and Prevention; IDSA = Infectious Diseases Society of America; NICE = National Institute for Health and Clinical Excellence; WHO = World Health Organization; TB = tuberculosis; R = rifampicin; H = isoniazid; Z = pyrazinamide; E = ethambutol; TBM = TB meningitis.
*
In populations with known or suspected high levels of isoniazid resistance, new TB patients may receive HRE as therapy in the continuation phase as an acceptable alternative to HR (weak/insufficient evidence, expert opinion).