Version May 2024
| Drug | Preparations | Doses¶ | |||
| Daily | 3x/week | 2x/week | 1x/week | ||
| First-line drugs | |||||
| IsoniazidΔ | Tablets (50 mg, 100 mg, 300 mg); elixir (50 mg/5 mL); aqueous solution (100 mg/mL) for intravenous or intramuscular injection | 5 mg/kg (usual maximum dose 300 mg) | 15 mg/kg (usual maximum dose 900 mg) | 15 mg/kg (usual maximum dose 900 mg) | 15 mg/kg (usual maximum dose 900 mg) |
| Rifampin (rifampicin)◊ | Capsules (150 mg, 300 mg); capsule contents may be suspended for oral administration; aqueous solution for intravenous injection | 10 mg/kg (usual maximum dose 600 mg) | 10 mg/kg (usual maximum dose 600 mg) | 10 mg/kg (usual maximum dose 600 mg) | – |
| Rifabutin◊ | Capsule (150 mg) | 5 mg/kg (usual maximum dose 300 mg) | Not recommended | Not recommended | – |
| Rifapentine◊ | Tablet (150 mg, film coated) | – | – | – | 10 to 20 mg/kg once weekly during continuation phase of treatment§ |
| Pyrazinamide¥ | Tablet (500 mg, scored) | Patient weight 40 to 55 kg‡ | |||
| 1000 mg (18.2 to 25 mg/kg) | 1500 mg (27.3 to 37.5 mg/kg) | 2000 mg (36.4 to 50 mg/kg) | – | ||
| Patient weight 56 to 75 kg‡ | |||||
| 1500 mg (20 to 26.8 mg/kg) | 2500 mg (33.3 to 44.6 mg/kg) | 3000 mg (40 to 53.6 mg/kg) | – | ||
| Patient weight 76 to 90 kg‡† | |||||
| 2000 mg** (22.2 to 26.3 mg/kg) | 3000 mg** (33.3 to 39.5 mg/kg) | 4000 mg** (44.4 to 52.6 mg/kg) | – | ||
| Ethambutol¶¶ | Tablets (100 mg, 400 mg) | Patient weight 40 to 55 kg‡ | |||
| 800 mg (14.5 to 20 mg/kg) | 1200 mg (21.8 to 30 mg/kg) | 2000 mg (36.4 to 50 mg/kg) | – | ||
| Patient weight 56 to 75 kg‡ | |||||
| 1200 mg (16 to 21.4 mg/kg) | 2000 mg (26.7 to 35.7 mg/kg) | 2800 mg (37.3 to 50 mg/kg) | – | ||
| Patient weight 76 to 90 kg‡ | |||||
| 1600 mg** (17.8 to 21.1 mg/kg) | 2400 mg** (26.7 to 31.6 mg/kg) | 4000 mg** (44.4 to 52.6 mg/kg) | – | ||
* Dosing based on actual weight is acceptable in patients who are not obese. For obese patients (>20% above ideal body weight [IBW]), dosing based on IBW may be preferred for initial doses. Some clinicians prefer a modified IBW (IBW + [0.40 × (actual weight – IBW)]) as is done for initial aminoglycoside doses. Because tuberculosis drug dosing for obese patients has not been established, therapeutic drug monitoring may be considered for such patients.
¶ Daily therapy is preferred over intermittent therapy to reduce risk of relapse and drug resistance; this is particularly important during the intensive phase of treatment. During the continuation phase of treatment, daily treatment is preferred over intermittent therapy; if daily therapy is not feasible, thrice-weekly dosing is preferred over twice-weekly dosing.
Δ Pyridoxine (vitamin B6; 25 to 50 mg/day) is given with isoniazid to individuals at risk for neuropathy (eg, pregnant women, breastfeeding infants, and individuals with HIV infection, diabetes, alcoholism, malnutrition, chronic renal failure, or advanced age). For patients with peripheral neuropathy, experts recommend increasing pyridoxine dose to 100 mg/day.
◊ Rifabutin dose may need to be adjusted when there is concomitant use of protease inhibitors or nonnucleoside reverse transcriptase inhibitors. Refer to the UpToDate topic on treatment of pulmonary tuberculosis in HIV-infected adults for specific dose adjustments.
§ Rarely used in practice; it may be an alternative in the continuation phase of treatment in a once-weekly regimen to facilitate directly observed therapy. For further details, refer to the UpToDate topic on rifamycins.
¥ For patients with creatinine clearance <30 mL/min (by Cockroft-Gault equation) or for patients receiving intermittent hemodialysis, pyrazinamide dosing consists of 25 to 35 mg/kg (ideal body weight) per dose orally 3 times per week (NOT daily); max 2.5 g per dose. On the day of hemodialysis, medications should be administered after hemodialysis. Monitoring of serum drug concentrations should be considered to ensure adequate drug absorption without excessive accumulation and to assist in avoiding toxicity.
‡ Based on estimated lean body weight.
† Patients >90 kg should have serum concentration monitoring. In obese patients, weight-based dosing is likely best based on measurements of ideal (versus total) body weight.
** Maximum dose regardless of weight.
¶¶ For patients with creatinine clearance <30 mL/min (by Cockroft-Gault equation) or for patients receiving intermittent hemodialysis, ethambutol dosing consists of 20 to 25 mg/kg (ideal body weight) per dose orally 3 times per week (NOT daily); max 1.6 g per dose. On the day of hemodialysis, medications should be administered after hemodialysis. Monitoring of serum drug concentrations should be considered to ensure adequate drug absorption without excessive accumulation and to assist in avoiding toxicity.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
