Management of Tuberculosis: Current Guidelines

Initial Treatment Regimen for Drug-Susceptible TB

The American Thoracic Society recommends a 6-month regimen consisting of isoniazid, rifampin, pyrazinamide, and ethambutol given daily for 2 months, followed by isoniazid and rifampin for 4 months 1
The Infectious Diseases Society of America suggests that ethambutol should be included in the initial regimen until drug susceptibility results are available, unless primary isoniazid resistance in the community is <4% 1

The Centers for Disease Control and Prevention recommend obtaining at least 3 sputum specimens for acid-fast bacilli (AFB) smear and culture before initiating treatment 1, 2
The World Health Organization suggests that at least one baseline specimen should be tested using a rapid molecular test (e.g., nucleic acid amplification test) 1
The American College of Chest Physicians recommends drug susceptibility testing for isoniazid, rifampin, ethambutol, and pyrazinamide must be performed on all initial isolates 1

The National Institutes of Health recommend monthly sputum smear and culture until 2 consecutive specimens are negative 1
The European Respiratory Society suggests that patients with positive smears at month 5 should be considered treatment failures 4, 5

The World Health Organization recommends that all patients should receive directly observed therapy where a treatment supporter watches medication ingestion 1, 4, 5

The Centers for Disease Control and Prevention suggest that if interruption <14 days, continue treatment to complete planned total number of doses (as long as all doses completed within 3 months) 1
The Infectious Diseases Society of America recommends that if interruption ≥14 days, restart treatment from the beginning 1

The American Thoracic Society recommends that for HIV-coinfected patients, initiate TB treatment first, before antiretroviral therapy (ART), to reduce risk of immune reconstitution inflammatory syndrome (IRIS) and better manage drug interactions 7
The National Institutes of Health suggest that for CD4 <50 cells/mm³, initiate ART within 2 weeks of starting TB treatment 6

The European Respiratory Society recommends that multidrug-resistant TB (resistance to at least isoniazid and rifampin) requires specialized treatment with second-line drugs 4, 5
The World Health Organization suggests that at least 4 drugs to which organisms are known or presumed susceptible should be used 4, 5

The Centers for Disease Control and Prevention recommend reporting all new and retreatment TB cases to local public health authorities within 1 week of diagnosis 1, 2
The American College of Chest Physicians suggests that a written record of all medications given, bacteriological response, and adverse reactions for all patients should be maintained 4, 5