Table 3. Regimen options for the initial treatment of TB among children and adults

Table 3. Regimen options for the initial treatment of TB among children and adults
TB Without HIV infection TB With HIV Infection
Option 1

Administer daily INH, RIF, and PZA for 8 weeks followed by 16 weeks of INH and RIF daily or 2-3 times/week* in areas where the INH resistance rate is not documented to be less than 4%. EMB or SM should be added to the initial regimen until susceptibility to INH and RIF is demonstrated. Continue treatment for at least 6 months and 3 months beyond culture conversion. Consult a TB medical expert if the patient is symptomatic or smear or culture positive after 3 months.
Options 1, 2, or 3 can be used, but treatment regimens should continue for a total of 9 months and at least 6 months beyond culture conversion.
Option 2

Administer daily INH, RIF, PZA, and SM or EMB for 2 weeks followed by 2 times/week* administration of the same drugs for 8 weeks (by DOT), and subsequently, with 2 times/week administration of INH and RIF for16 weeks (by DOT). Consult a TB medical expert if the patient is symptomatic or smear or culture positive after 3 months.
Option 3

Treat by DOT, 3 times/week* with INH, RIF, PZA, and EMB or SM for 6 months+. Consult a medical expert if the patient is symptomatic or smear or culture positive after 3 months.
* All regimens administered 2 times/week or 3 times/week should be monitored by DOT for the duration of therapy.

+ The strongest evidence from clinical trials is the effectiveness of all four drugs administered for the full6 months. There is weaker evidence that SM can be discontinued after 4 months if the isolate is susceptible to all drugs. The evidence for stopping PZA before the end of 6 months is equivocal for the 3 times/week regimen, and there is no evidence on the effectiveness of this regimen with EMB for less than the full 6 months.

DOT=Directly observed therapy; INH=isoniazid; RIF=rifampin; PZA=pyrazinamide; EMB=ethambutol; SM=streptomycin.

SOURCE: Centers for Disease Control and Prevention (1993).

From: Chapter 7 - Tuberculosis

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Screening for Infectious Diseases Among Substance Abusers.
Treatment Improvement Protocol (TIP) Series, No. 6.
Center for Substance Abuse Treatment.

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