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Drug-Susceptible Tuberculosis

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23 Table 11. Dosing Recommendations for Adult Patients With Reduced Renal Function a Drug Change in Frequency? Recommended Dose and Frequency for Patients With Creatinine Clearance <30 mL/min, or Patients Receiving Hemodialysis Isoniazid No 300 mg once daily, or 900 mg 3 times/wk Rifampin No 600 mg once daily, or 600 mg 3 times/wk Pyrazinamide Yes 25–35 mg/kg/dose 3 times/wk (not daily) Ethambutol Yes 20–25 mg/kg/dose 3 times/wk (not daily) Levofloxacin Yes 750–1000 mg/dose 3 times/wk (not daily) Moxifloxacin No 400 mg once daily Cycloserine Yes 250 mg once daily, or 500 mg/dose 3 times/wk b Ethionamide No 250–500 mg/dose daily Para-amino salicylic acid No 4 g/dose twice daily Streptomycin Yes 15 mg/kg/dose 2–3 times/wk (not daily) Capreomycin Yes Kanamycin Yes Amikacin Yes • Standard doses are given unless there is intolerance. • The medications should be given after hemodialysis on the day of hemodialysis. • Monitoring of serum drug concentrations should be considered to ensure adequate drug absorption, without excessive accumulation, and to assist in avoiding toxicity. • Data currently are not available for patients receiving peritoneal dialysis. Until data become available, begin with doses recommended for patients receiving hemodialysis and verify adequacy of dosing using serum concentration monitoring. • In patients with 30–50 mL/min creatinine clearance, standard doses are used by experts, but measurement of serum concentrations 2 and 6 hours after timed administration can be used to assist with optimizing drug dosages. a Including adult patients receiving hemodialysis. b e appropriateness of 250-mg daily doses has not been established. ere should be careful monitoring for evidence of neurotoxicity.

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