What is the treatment for Tuberculosis (TB)?

From the Guidelines

The treatment for Tuberculosis (TB) should consist of an initial 2-month phase of isoniazid, rifampin, pyrazinamide, and ethambutol, followed by a continuation phase of isoniazid and rifampin lasting >4 months, for a minimum total treatment period of 6 months, as recommended by the CDC 1. The goal of this treatment regimen is to ensure that the TB bacteria are fully eradicated, reducing the risk of relapse and the development of drug-resistant strains.

• The initial phase of treatment typically involves a combination of four medications: isoniazid, rifampin, ethambutol, and pyrazinamide, which are given for the first 2 months.
• The continuation phase involves isoniazid and rifampin, which are given for an additional 4 months.
• The decision to stop therapy should be based on the number of doses taken within a maximum period, rather than simply a 6-month period, to ensure that the patient has received an adequate course of treatment.
• Patients with cavitary pulmonary TB disease and positive cultures of sputum specimens at the completion of 2 months of therapy may require a longer, 7-month continuation phase of therapy, for a total duration of 9 months, due to the higher rate of relapse in this population 1.
• Directly observed therapy (DOT) is often recommended to ensure adherence to the treatment regimen and prevent the development of drug-resistant strains.
• Patients should be monitored for side effects, including liver damage and vision changes, and isoniazid can cause peripheral neuropathy, so vitamin B6 (pyridoxine) is often prescribed alongside it.

From the FDA Drug Label

Pyrazinamide is indicated for the initial treatment of active tuberculosis in adults and children when combined with other antituberculous agents (The current recommendation of the CDC for drug-susceptible disease is to use a six-month regimen for initial treatment of active tuberculosis, consisting of isoniazid, rifampin and pyrazinamide given for 2 months, followed by isoniazid and rifampin for 4 months. Rifampin for Injection, USP is indicated in the treatment of all forms of tuberculosis A three-drug regimen consisting of rifampin, isoniazid, and pyrazinamide is recommended in the initial phase of short-course therapy which is usually continued for 2 months

The treatment for Tuberculosis (TB) is a combination of antituberculous agents. The recommended regimen for drug-susceptible disease is:

• Isoniazid, rifampin, and pyrazinamide for 2 months, followed by
• Isoniazid and rifampin for 4 months. This regimen may be modified based on susceptibility testing and patient response 2, 3.

From the Research

Treatment for Active Tuberculosis (TB)

• The standard treatment for active TB typically involves a combination of four drugs: isoniazid, rifampin, pyrazinamide, and ethambutol, for the initial two-month phase, followed by isoniazid and rifampin for 4 to 7 months 4.
• Directly-observed therapy (DOT) is the standard of care for pulmonary TB, and virtual treatment monitoring using digital technologies is becoming more common 4.
• The treatment regimen may vary depending on the risk of drug-resistant disease, with recently approved medications recommended only for drug-resistant disease 4.

Treatment for Latent Tuberculosis (LTBI)

• The standard treatment for LTBI is nine months of isoniazid taken daily, or twice weekly under direct observation by a healthcare worker 5.
• Alternative regimens include once-weekly isoniazid and rifapentine for 12 weeks under direct observation, which has been shown to be safe and effective 4, 5.
• Newer studies are investigating even shorter LTBI treatment regimens with durations of less than 2 months 4.

Treatment for Drug-Resistant TB

• Confirmed multidrug-resistant tuberculosis or extensively drug-resistant tuberculosis should be treated with directly observed therapy in collaboration with a clinician familiar with management of these conditions 5.
• Treatment must include at least 4 drugs to which the organism is susceptible, and the duration of therapy should usually be 18-24 months 5.

Shortened Treatment Regimens

• Recent studies have investigated the use of shortened treatment regimens, including fluoroquinolone-containing four-month regimens, but the evidence does not support their use in adults with newly diagnosed drug-sensitive pulmonary tuberculosis 6.
• Shortened regimens have been shown to increase the risk of relapse compared to standard six-month regimens, although treatment success and serious adverse events are similar 6.