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Suggested regimens for treatment of drug-resistant latent tuberculosis

Suggested regimens for treatment of drug-resistant latent tuberculosis
Pattern of drug resistance Suggested regimen Duration of treatment*
INH, RIF Fluoroquinolone (levofloxacin or moxifloxacin) with or without EMB 6 to 12 months
INH, RIF, EMB Fluoroquinolone (levofloxacin or moxifloxacin) with or without ETA 6 to 12 months
INH, RIF, PZA Fluoroquinolone (levofloxacin or moxifloxacin) with or without EMB 6 to 12 months
INH, RIF, PZA, EMB +/– injectable Fluoroquinolone (levofloxacin or moxifloxacin) with or without ETA 6 to 12 months
INH, RIF, PZA, EMB, injectable, ETA Fluoroquinolone (levofloxacin or moxifloxacin) with or without CS 6 to 12 months
INH, RIF, PZA, EMB, fluoroquinolone (levofloxacin or moxifloxacin) See note 6 to 12 months
The term "drug-resistant tuberculosis" refers to tuberculosis caused by an isolate of Mycobacterium tuberculosis that is resistant to one of the first-line anti-tuberculosis drugs: isoniazid, rifampin, pyrazinamide, ethambutol, or streptomycin.
INH: isoniazid; RIF: rifampin; EMB: ethambutol; ETA: ethionamide; PZA: pyrazinamide; CS: cycloserine; PAS: para-aminosalicyclic acid.
* Longer duration (12 months) of therapy is warranted for patients with immunosuppression, children <5 years, and individuals with other substantial risk for progression to active TB disease; shorter duration (6 months) is appropriate for other individuals.
¶ When the resistance pattern limits options for treatment of latent tuberculosis to toxic combinations, clinical monitoring (symptom review every three to six months for two years with chest radiographs and/or sputum collection as clinically indicated) in the absence of treatment is reasonable. Prompt pursuit of treatment is warranted for patients with immunosuppression, children <5 years, and individuals with other substantial risk for progression to active TB disease; in such cases, possible regimens include two of the following agents: CS, PAS, and ETA.
Graphic 108730 Version 4.0