Revisedtuberculosistreatmentguidelines2003-poster.p65

Tuberculosis Education Center/TB Elimination Division/Texas Department of Health
Phone: (210) 534-8857 ext. 2489, Patient Information Fax: (210) 531-4500 Web Address: www.tdh.state.tx.us/tcid/TB-Education-Ctr.htm
1-800-TEX-LUNG
Revised Tuberculosis Treatment Guidelines-2003
For additional information, refer to the printed guidelines.
TABLE 2. DRUG REGIMENS FOR CULTURE-POSITIVE PULMONARY TUBERCULOSIS CAUSED BY DRUG-SUSCEPTIBLE ORGANISMS
INITIAL PHASE
CONTINUATION PHASE
TOTAL DOSES
Seven days per week for 56 doses (8 weeks) 182 - 130 (26 weeks)
OR five days per week for 40 doses (8 weeks)¤
weeks) OR five days per week for 90 doses
92 - 76 (26 weeks)
74 OR 58 (26 weeks)
Seven days per week for 14 doses (2 weeks) then
62 - 58 (26 weeks)
twice-weekly for 12 doses (6 weeks) OR five days
per week for 10 doses (2 weeks)¤ then twice-weekly
44 OR 40 (26 weeks)
Seven days per week for 56 doses (8 weeks) OR
273 - 195 (39 weeks)
five days per week for 40 doses (8 weeks)¤ (31 weeks) OR five days per week for
INH = isoniazid, RIF = rifampin, RPT = rifapentine, PZA = pyrazinamide, EMB = ethambutol 118 - 102 (39 weeks)
‡When DOT is used drugs may be given 5 days per week and the necessary number of doses adjusted accordingly. Although there are not studies that compare 5 with 7 daily doses, extensive experience indicates this would be an effective practice for drug susceptible tuberculosis.
**Options 1c and 2b should only be used in HIV negative patients who have negative sputum smears at the time of completion of 2 months of therapy and who do not have cavitations on initial chest radiograph. For patients started on this regimen and found to have a positive
culture at 2 months, treatment should be extended an extra 3 months.
# Patients with cavitations on initial chest radiograph and positive cultures at completion of 2 months of therapy should receive a 7-month continuation phase.
§Not recommended for HIV-infected patients with CD4 cell counts < 100 cells/ml. Five-day-a-week administration is always given by DOT.
¤Rating for 5 day a week regimens is AIII.
*A = preferred; B = acceptable alternative; C = offer when A and B cannot be given; E = should never be given.
†I = randomized clinical trial; II = data from clinical trials that were not randomized or were conducted in other populations; III = expert opinion.
TABLE 4. SUGGESTED PYRAZINAMIDE DOSES, USING WHOLE TABLETS,
TABLE 5. SUGGESTED ETHAMBUTOL DOSAGES, USING WHOLE TABLETS,
FOR ADULTS WEIGHING 40-90 Kg
FOR ADULTS WEIGHING 40-90 Kg
†Based on estimated lean body weight.
‡Maximum dose regardless of weight.
TABLE 13. EVIDENCE-BASED GUIDELINES FOR THE TREATMENT OF ADULTS WITH DRUG-SUSCEPTIBLE**
TABLE 14. SUMMARY OF EVIDENCE FOR TREATMENT OF PERSONS WITH
EXTRAPULMONARY TUBERCULOSIS AND ADJUNCTIVE USE OF CORTICOSTEROIDS
RADIOGRAPHIC EVIDENCE OF PRIOR TUBERCULOSIS AND
NEGATIVE SPUTUM CULTURES NOT TREATED PREVIOUSLY
Definitions of evidence ratings
*A = preferred; B = acceptable alternative; C = offer when A and B cannot be given; D= should generally not be given; E = should never be given.
†I = randomized clinical trial; II = data from clinical trials that were not randomized or **Corticosteroid therapy should not be administered unless the organisms are known or presumed to be susceptible to the first-line drugs.
were conducted in other populations; III = expert opinion.
TABLE 15. DOSING RECOMMENDATIONS FOR ADULT PATIENTS WITH REDUCED RENAL FUNCTION AND FOR ADULT PATIENTS RECEIVING HEMODIALYSIS
Recommended Dose And Frequency For Patients WithCreatinine Clearance < 30 Ml/Min. Or Patients Receiving Hemodialysis 300 mg once daily, or 900 mg three times/week 1. Standard doses are given unless there is intolerance.
600 mg once daily, or 600 mg three times/week 2. The medications should be given after hemodialysis on the day of hemodialysis.
25-35 mg/kg/dose three times/week (not daily) 3. Monitoring of serum drug concentrations should be considered to ensure adequate drug 15-25 mg/kg/dose three times/week (not daily) absorption, without excessive accumulation, and to assist in avoiding toxicity.
750-1000 mg/dose three times/week (not daily) 4. *The appropriateness of 250 mg daily doses has not been established.
250 mg once daily, or 500 mg/dose three times/week* 5. There should be careful monitoring for evidence of neurotoxicity.
6. Data currently are not available for patients receiving peritoneal dialysis. Until data become available, begin with doses recommended for patients receiving hemodialysis and 12-15 mg/kg/dose two-three times/week (not daily) verify adequacy of dosing using serum concentration monitoring.
12-15 mg/kg/dose two-three times/week (not daily) 12-15 mg/kg/dose two-three times/week (not daily) 12-15 mg/kg/dose two-three times/week (not daily) FIGURE 5. MANAGEMENT OF TREATMENT INTERRUPTIONS
HOW TO MONITOR
% planned doses in continuation phase completed *Patients who were initially AFB smear positive should HCV, HBV - If risk factors exist
*HIV, foreign birth in Asia or Africa, IVDU †Recheck smears and cultures (if positive, check drug Baseline labs on all: Platelets, LFT’s, Bilirubin,
susceptibility results). Start DOT if not already being used.
Alkaline Phosphatase, HIV, Cr
Continue treatment; If total Restart from Additional treatment may not be necessary*.
not completed in 3 months, beginning.
§If repeat culture is positive, restart 4-drug regimen while waiting for drug susceptibility results. If repeat culture is For pulmonary TB - Monthly sputum until 2 consecutive
negative, continue therapy to complete regimen within 9 cultures are negative
‡If repeat culture is positive, continue 4-drug regimen while waiting for drug susceptibility results. If repeat culture is Assessment of visual acuity and red-green color vision negative, consider stopping therapy if patient has received Created: February 1, 2003 TDH E-Publication #: E40-11616 Printing supported by the Health Education Training Centers Allianceof Texas-South Central Region (HETCAT-SCR) Educational Grant.

Source: http://www.tbrec.org/Documents/New-Tuberculosis-Treatment-Guidelines-2003.pdf