Spectrum: Local Antimicrobial Stewardship, for UCLA Health

Active TB

Note

  •  Infectious Diseases consult is strongly advised.

  •  LA County TB Control must approve ALL discharge plans for patients with active TB (“Gotch Law”).

  • Infection Prevention must assist with decisions about isolation and discharge plans.

Therapy should be initiated for patients with positive AFB smear and clinical findings consistent with active TB.

Therapy should be considered for patients with negative AFB smears when suspicion of TB is high and no alternate diagnosis exists. Multiple specimens should be obtained for culture prior to initiation of treatment.

Treatment

Four drugs are necessary for the initial phase (2 months)

Isoniazid (INH) 300 mg* (5 mg/kg)
PO daily

Rifampin (RIF) 600 mg* (10 mg/kg)
PO daily

Pyrazinamide (PZA)
1000 mg (40-55 kg) OR
1500 mg (56-75 kg) OR
2000 mg* (76-90 kg)
PO daily

Ethambutol (EMB)
800 mg (40-55 kg) OR
1200 mg (56-75 kg) OR
1600 mg* (76-90 kg)
PO daily

*Max dose, regardless of weight

ALSO CONSIDER

Pyridoxine 25-50 mg PO daily

Recommended to prevent INH-associated peripheral neuropathy in patients with: HIV, malnutrition, alcohol abuse, diabetes mellitus, renal failure, pregnancy, or breastfeeding.

Toxicity Information
(INH, RIF, PZA, EMB)