Adult Outpatients: Respiratory Tract Infections: Tuberculosis

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Doses provided in this table are for patients with normal renal and hepatic function. Click on drug link to go to dosing guidelines.  Some antimicrobials are restricted (ID-R).  Click on link for guidelines on obtaining authorization.

Diagnosis

Common Pathogens

Drug(s) of First Choice

Alternative Drug(s)

Comments

Treatment of active tuberculosis

Mycobacterium tuberculosis

 

Isoniazid 300 mg PO daily x 6 months

PLUS

Rifampin 600 mg PO daily x 6 months

PLUS

Pyrazinamide 25 mg/kg PO daily x 2 months

PLUS

Ethambutol 15 mg/kg PO daily until Isoniazid or Rifampin sensitivity established

PLUS:

Pyridoxine (Vitamin B-6) 50 mg PO daily for 6 months

 

 

All cases of active tuberculosis must be reported to San Francisco Department of Public Health Tuberculosis Control (http://www.sftbc.org/) at 415-206-8524 within one working day.

 

Smear positive cases should receive directly observed therapy.  Other cases often receive directly observed therapy at the discretion of the Tuberculosis Control Unit.

 

Obtain baseline LFT’s on all patients. Additional LFT’s advised if liver disease present.  Perform a monthly symptom review if LFTs are normal.

 

Rifampin has numerous clinically significant drug interactions.  Medication lists should be reviewed for potential drug-drug interactions with rifampin.

Latent TB

 

Isoniazid 300 mg PO daily x 9 months

Rifampin 600 mg PO daily x 4 months 

Baseline LFTs are optional in healthy patients with no risk factors.  Baseline & 4-8 weeks LFTs for liver disease, chronic alcohol use, HIV, pregnant & postpartum. Clinical monitoring for hepatic injury symptoms at all visits.