Treatment of Drug-Susceptible Tuberculosis
Publication Date: August 10, 2016
Treatment
Organization and Supervision of Treatment
Recommendation 1: The panel suggests using case management interventions during treatment of patients with tuberculosis. (C, VL)
620
Recommendation 2: The panel suggests using DOT rather than SAT for routine treatment of patients with all forms of tuberculosis. (C, L)
620
Recommended Treatment Regimens
Recommendation 3a: The panel recommends the use of daily rather than intermittent dosing in the intensive phase of therapy for drug susceptible pulmonary tuberculosis. (S, M)
620
Recommendation 3b: Use of thrice-weekly therapy in the intensive phase (with or without an initial 2 weeks of daily therapy) may be considered in patients who are not HIV infected and are also at low risk of relapse (pulmonary tuberculosis caused by drug-susceptible organisms, that at the start of treatment is non-cavitary and/or smear negative). (C, L)
620
Recommendation 3c: In situations where daily or thrice-weekly DOT therapy is difficult to achieve, use of twice-weekly therapy after an initial 2 weeks of daily therapy may be considered for patients who are not HIV-infected and are also at low risk of relapse (pulmonary tuberculosis caused by drug-susceptible organisms, that at the start of treatment is non-cavitary and/or smear negative). (C, VL)
620
Recommendation 4a: The panel recommends the use of daily or thrice weekly dosing in the continuation phase of therapy for drug susceptible pulmonary tuberculosis. (S, M)
620
Recommendation 4b: If intermittent therapy is to be administered in the continuation phase, then the panel suggests use of thrice-weekly instead of twice-weekly therapy. (C, L)
620
Recommendation 4c: The panel recommends against INH 900 mg and rifapentine 600 mg in the continuation phase. (S, H)
620
Treatment in Special Situations
Recommendation 5a: For HIV-infected patients receiving ART, the panel suggests using the standard 6-month daily regimen consisting of an intensive phase of 2 months of INH RIF, PZA, and EMB followed by a continuation phase of 4 months of INH and RIF for the treatment of drug-susceptible pulmonary tuberculosis. (C, VL)
620
Recommendation 5b: In uncommon situations in which HIV-infected patients do NOT receive ART during tuberculosis treatment, the panel suggests extending the continuation phase with INH and RIF for an additional 3 months (ie, a continuation phase of 7 months in duration, corresponding to a total of 9 months of therapy) for treatment of drug susceptible pulmonary tuberculosis. (C, VL)
620
Recommendation 6: The panel recommends initiating ART during tuberculosis treatment. ART should ideally be initiated by 8–12 weeks of tuberculosis treatment initiation for patients with CD4 counts ≥50 cells/μL. ART should ideally be initiated within the first 2 weeks of tuberculosis treatment for patients with CD4 counts <50* cells/μL. (S, H)
620
Extrapulmonary Tuberculosis
Recommendation 7: The panel suggests initial adjunctive corticosteroid therapy NOT be routinely used in patients with tuberculous pericarditis. (C, VL)
620
Recommendation 8: The panel recommends initial adjunctive corticosteroid therapy with dexamethasone or prednisolone tapered over 6–8 weeks for patients with tuberculous meningitis. (S, M)
620
Culture-Negative Pulmonary Tuberculosis in Adults
Recommendation 9: The panel suggests that a 4-month treatment regimen is adequate for treatment of HIV-uninfected adult patients with AFB smear- and culture-negative pulmonary tuberculosis. (C, VL)
620
Title
Treatment of Drug-Susceptible Tuberculosis
Authoring Organizations
American Thoracic Society
Centers for Disease Control and Prevention
Infectious Diseases Society of America
Publication Month/Year
August 10, 2016
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Male, Adolescent, Adult, Child, Infant, Older adult
Health Care Settings
Ambulatory
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Management, Treatment
Diseases/Conditions (MeSH)
D014376 - Tuberculosis
Keywords
tuberculosis, Mycobacterium tuberculosis, antitubercular agents, Drug-Susceptible Tuberculosis, TB, TB, tb, Tuberculosis
Source Citation
Payam Nahid, Susan E. Dorman, Narges Alipanah, Pennan M. Barry, Jan L. Brozek, Adithya Cattamanchi, Lelia H. Chaisson, Richard E. Chaisson, Charles L. Daley, Malgosia Grzemska, Julie M. Higashi, Christine S. Ho, Philip C. Hopewell, Salmaan A. Keshavjee, Christian Lienhardt, Richard Menzies, Cynthia Merrifield, Masahiro Narita, Rick O'Brien, Charles A. Peloquin, Ann Raftery, Jussi Saukkonen, H. Simon Schaaf, Giovanni Sotgiu, Jeffrey R. Starke, Giovanni Battista Migliori, Andrew Vernon, Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis, Clinical Infectious Diseases, Volume 63, Issue 7, 1 October 2016, Pages e147–e195, https://doi.org/10.1093/cid/ciw376