Management of drug-susceptible pulmonary tuberculosis in adults (traditional regimen) at 2-month juncture: sputum AFB culture positive

Drug dosing is summarized separately (refer to text and related tables).
The algorithm is designed based on assumption that positive AFB cultures reflect Mycobacterium tuberculosis; identification of non-tuberculous mycobacteria should prompt adjustment of therapy accordingly (refer to UpToDate content on nontuberculous mycobacteria).
The algorithm is designed based on assumption that patient has drug-susceptible disease; drug susceptibility data should be reviewed and identification of drug resistance should prompt adjustment of therapy accordingly (refer to UpToDate content on drug-resistant tuberculosis).
During treatment of pulmonary tuberculosis, sputum should be obtained for AFB smear and culture at monthly intervals until 2 consecutive cultures are negative. Presence of positive sputum AFB culture after 3 months of antituberculous therapy should prompt drug susceptibility testing and review of causes for reatment failure. Presence of positive sputum cultures after 4 months of antituberculous therapy reflects treatment failure; refer to text for discussion of management.
Directly observed therapy with individual, patient-centered case management is preferred for all patients, to ensure adherence and prevent emergence of drug resistance.

AFB: acid-fast bacilli.
* Pyrazinamide may be discontinued after it has been taken for 2 months (56 doses).
¶ Ethambutol may be discontinued when results of drug susceptibility testing indicate no drug resistance to first-line agents.
Δ Worsening chest radiographi findings or clinical manifestations prior to initiation of continuation phase should prompt consideration of drug-resistant tuberculosis or alternate diagnosis; refer to text for further discussion.
◊ Use of once-weekly therapy with isoniazid and rifapentine in the continuation phase, or twice-weekly therapy with isoniazid and rifampin in the continuation phase are no longer recommended except for unusual circumstances to facilitate directly observed therapy. In addition, rifapentine should not be used in patients with extrapulmonary tuberculosis.
§ Patients with drug-resistant isolates should be treated as discussed separately (refer to UpToDate topics treatment of pulmonary tuberculosis and drug-resistant tuberculosis).

References:

Nahid P, Dorman SE, Alipanah N, et al. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis. Clin Infect Dis 2016; 63:e147.
Centers for Disease Control and Prevention. Treatment of Tuberculosis, American Thoracic Society, CDC, and Infectious Diseases Society of America. MMWR 2003;52(No. RR-11).

Graphic 132655 Version 2.0

خرید پکیج

Management of drug-susceptible pulmonary tuberculosis in adults (traditional regimen) at 2-month juncture: sputum AFB culture positive