Chapter 7 : Chemotherapy of Tuberculosis

Management of drug-susceptible TB. aEMB may be discontinued if isolate is known to be susceptible to INH, RIF, and PZA. bDelayed culture conversion should prompt consideration of acquired drug resistance, noncompliance, and malabsorption. cAdditional duration of treatment may be considered in the following settings: delayed clinical or radiographic improvement, cavitary disease regardless of sputum conversion, extensive disease, active smoking, diabetes, HIV, > 10% below ideal body weight, or other immunocompromising conditions.

Management of hepatotoxicity. (Prompt referral to a specialist may be indicated if dysfunction is severe or patient does not improve promptly.) aIf cholestatic pattern, RIF likely etiology and rifabutin may be appropriate substitute after normalization of LFT’s. bIf patient has extensive disease, meningitis, HIV coinfection, or requires a prolonged period off first-line agents, prompt initiation of a nonhepatotoxic regimen such as EMB, a fluoroquinolone, cycloserine, and an aminoglycoside should be pursued. cReferal to a hepatologist or gastroenterologist may be indicated for delayed improvement or severe symptoms (i.e., intractable nausea and vomiting, elevated INR, lethargy, or coma). dRechallenge with PZA can be considered if hepatitis was not severe. eSee “Treatment Regimens”.