Recommended treatment regimens for each diagnostic category

(World Health Organization. Treatment of tuberculosis. Guidelines for national programmes.Third edition. Geneva, 2003) (WHO/CDS/TB/2003.313)

diagnostic category

TB patients

TB treatment regimens

Initial phase

(daily or 3 times weekly)a

Continuation phase (daily or 3 times weekly)a

New smear-negative pulmonary TB with extensive parenchymal involvement. Severe concomitant HIV disease or severe forms of extrapulmonary TB.

2HRZEb

(or 6HE dailyc)

II

Previously treated sputum smear-positive pulmonary TB:

- relapse

- treatment after default

- treatment failured.

2 HRZES/IHRZE

5HRE

III

New smear-negative pulmonary TB (other than in Category I). Less severe forms of extrapulmonary TB.

2HRZEe

(or 6HE dailyc)

IV

Chronic and MDR-TB cases (still sputum-positive after supervised re-treatment)f.

Specially designed individualized or standardized regimens are suggested for this category (refer to the current WHO TB treatment guidelines, Chapter 5)

a Direct observation of drug intake is required during the initial phase of treatment in , smear-positive cases, and always in treatment including rifampicin. b Streptomycin may be used instead of ethambutol. In TB meningitis, ethambutol should be replaced by streptomycin. c This regimen may be associated with a higher rate of treatment failure and relapse compared with the 6-month regimen with rifampicin in the continuation phase (refer to , the current WHO TB treatment guidelines, section 4.8)

d Whenever possible, drug sensitivity testing is recommended before prescribing Category II treatment in failure cases. It is recommended that patients with proven MDR-TB use Category IV regimens (refer to the current WHO TB treatment guidelines, Chapter 5). e Ethambutol may be omitted during the initial phase of treatment for patients with non-cavitary, smear-negative pulmonary TB who are known to be HIV-negative, patients known f to be infected with fulty drug-susceptible bacilli, and young children with primary TB. f Contacts of patients with culture-proven MDR-TB should be considered for early culture and sensitivity testing.

Some authorities recommend a 7 month continuation phase with daily isoniazid and rifampicin (7HR) for Category 1 patients with particular forms of TB. These are TB meningitis, miliary TB and spinal TB with neurological signs.

Fixed-dose combination drugs (FDC) should be recommended wherever they are available, especially for regimens containing rifampicin in the continuation phase or when direct observation is not fully guaranteed.

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