II. Indications

  1. Isoniazid Resistance >4% in patient's community
  2. Human Immunodeficiency Virus (HIV)
  3. Prior Tuberculosis exposure

III. Precautions

  1. This protocol is from 2003 without available new guidance to use for update as of 2016 review
  2. Multi-drug resistance requires expert local opinion for guidance

IV. Management

  1. Initial: Four drug therapy for 2 months
    1. Isoniazid
    2. Rifampin
    3. Pyrazinamide
    4. Ethambutol or Streptomycin
  2. Subsequent Dosing
    1. If Isoniazid susceptible, treat for 6 months
      1. Isoniazid
      2. Rifampin
    2. If Isoniazid resistant THEN
      1. Protocol A: Treat for 6 months
        1. Rifampin
        2. Pyrazinamide AND
        3. Ethambutol OR Streptomycin
      2. Protocol B: Treat for 12 months
        1. Rifampin
        2. Ethambutol
    3. If Extrapulmonary Tuberculosis, treat for >9 months
      1. Disseminated tuberculosis
      2. Osteomyelitis
      3. Meningitis
      4. Human Immunodeficiency Virus (HIV)
    4. If TuberculosisMeningitis
      1. Continue Pyrazinamide for full course

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