Tuberculosis Treatment Guidelines

Standard Daily Dosing Regimen for Adults

The American Thoracic Society recommends isoniazid 5 mg/kg daily (maximum 300 mg), rifampicin 10 mg/kg daily (maximum 600 mg), pyrazinamide 25 mg/kg daily (maximum 2000 mg), and ethambutol 15-20 mg/kg daily (maximum 1600 mg) for adults with pulmonary tuberculosis 1, 2
The standard 6-month regimen consists of a 2-month intensive phase with all four drugs, followed by a 4-month continuation phase with isoniazid and rifampicin 2

For twice-weekly dosing, the recommended doses are isoniazid 15 mg/kg (maximum 900 mg), rifampicin 10 mg/kg (maximum 600 mg), pyrazinamide 50-70 mg/kg (maximum 3000 mg), and ethambutol 50 mg/kg (maximum 2500 mg) 1, 2, 5
For three-times-weekly dosing, the recommended doses are isoniazid 15 mg/kg (maximum 900 mg), rifampicin 10 mg/kg (maximum 600 mg), pyrazinamide 50-70 mg/kg (maximum 3000 mg), and ethambutol 50 mg/kg (maximum 2500 mg) 2, 5

Children require higher per-kilogram doses, with recommended daily doses of isoniazid 10-15 mg/kg (maximum 300 mg), rifampicin 10-20 mg/kg (maximum 600 mg), pyrazinamide 15-30 mg/kg (maximum 2000 mg), and ethambutol 15-25 mg/kg (maximum 2500 mg) 2, 5
For intermittent pediatric dosing, isoniazid increases to 20-40 mg/kg (maximum 900 mg) twice weekly 2, 5

Maximum daily doses exist to prevent toxicity and should not be exceeded: isoniazid 300 mg daily, 900 mg intermittent; rifampicin 600 mg; pyrazinamide 2000 mg daily, 3000 mg intermittent; ethambutol 1600 mg daily, 2500 mg intermittent 1, 2, 5
The same weight-based dosing applies for genitourinary TB, with identical intensive and continuation phases as pulmonary disease 1
Intermittent dosing requires substantially higher per-kilogram doses to maintain therapeutic drug levels, and it is critical to verify whether the regimen is daily or intermittent before calculating doses 2, 5