Key Principles

  • Tuberculosis treatment should always be undertaken in consultation with a physician who is well-versed and experienced in management.
  • All patients should be initially started on a 4-drug regimen of Isoniazid (INH), Rifampin (RIF), Pyrazinamide (PZA) and Ethambutal (EMB).  Following the initial 8-week phase of treatment, the continuation phase should consist of INH and RIF in pansensitive cases.
  • Directly Observed Therapy (DOT) is the international standard of care for all patients with TB disease and is essential for management of cases of multidrug-resistant TB (MDR-TB).
  • Patients with TB should have monthly monitoring of sputum for AFB smear and culture, until negative
  • For all patients, drug susceptibility testing should be done on the initial M. tuberculosis isolate.  Susceptibility testing should be repeating for patients who are not responding to therapy or who have positive cultures after 3 months of therapy.
  • Treatment regiments for pulmonary TB are also effective for treating pulmonary TB
  • All new and suspected cases of active TB should be reported to state and/or local health departments
  • A single drug should never be added to a failing treatment regimen.  Treatment of suspected drug-resistant TB should always include 2-3 new drugs
  • Based on medication history and drug susceptibility results, treatment for MDR-TB (i.e., resistance to at least INH and RIF must be daily, individualized and prolonged.  It is vital to seek expert consultation.
  • Treatment of tuberculosis benefits both the community as a whole and the individual patient; thus, any public health program or private provider must not only prescribe an appropriate regimen, but also ensure adherence until treatment completion.