Pulmonary Tuberculosis Treatment Guidelines

Drug-Susceptible Pulmonary Tuberculosis

The American Thoracic Society recommends a 6-month regimen consisting of isoniazid, rifampin, pyrazinamide, and ethambutol (HRZE) for 2 months, followed by isoniazid and rifampin (HR) for 4 months, given daily 1, 2
The Centers for Disease Control and Prevention suggests that ethambutol can be discontinued once drug susceptibility testing confirms full susceptibility to isoniazid and rifampin, particularly in patients with low risk for drug resistance (community isoniazid resistance ≤4%) 1
The World Health Organization recommends rifampin dosing: Adults <50 kg receive 450 mg daily; adults ≥50 kg receive 600 mg daily 3
The American College of Chest Physicians recommends isoniazid and rifampin (HR) for 4 months after completing the intensive phase 1, 2

The World Health Organization recommends the shorter 6-month all-oral bedaquiline-containing regimen for MDR-TB meeting specific criteria; otherwise, use an individualized longer regimen of 18 months duration 5, 6
The International Journal of Infectious Diseases suggests eligibility criteria for shorter regimens: MDR/RR-TB or pre-XDR-TB confirmed, no resistance to fluoroquinolones, no extensive TB (spinal/CNS/miliary), not pregnant, and age >6 years 5, 6
The European Respiratory Society recommends BPaLM regimen composition: Bedaquiline, pretomanid, linezolid, and moxifloxacin, with a duration of 6 months total 6

The Centers for Disease Control and Prevention recommends that for HIV-infected patients receiving antiretroviral therapy (ART), use the standard 6-month daily regimen (2 months HRZE, 4 months HR) 1, 2
The Infectious Diseases Society of America suggests that for HIV-infected patients NOT receiving ART, extend continuation phase to 7 months (total 9 months of therapy) 1, 2
The American College of Obstetricians and Gynecologists recommends that for pregnant women, use the standard regimen: Rifampin, isoniazid, ethambutol, and pyrazinamide can all be used during pregnancy 8

The World Health Organization recommends monitoring with follow-up sputum smear microscopy and culture for pulmonary TB 3
The International Journal of Infectious Diseases suggests considering rifampin blood level monitoring if poor response due to under-dosing or malabsorption is suspected 3
The European Respiratory Society recommends monitoring for hepatotoxicity, especially during the first 2 months of treatment 3, 4
The American Thoracic Society suggests monitoring for QTc prolongation with bedaquiline, delamanid, and fluoroquinolones 5, 6