ATS GUIDELINES Bundle

12 Treatment Table 2b. Doses of Drugs for Treatment of Adults and Children with MDR-TB STEP Drug Route of Admin- istration Adults 5 Delamanid PO 100 mg twice daily Ethambutol PO / IV Low dose (companion drug ): 15 mg/kg daily High dose (bacteriostatic drug ): 25–30 mg/kg daily Pyrazinamide PO 25–40 mg/kg daily 6 Ethionamide PO 15–20 mg/kg total (usually 250–500 mg once or twice daily) g Prothionamide PO 15–20 mg/kg total (usually 250–500 mg once or twice daily) Imipenem-cilastatin IV 1000 mg 3–4× a day Meropenem IV 1000 mg 3× a day h Clavulanate (component of amoxicillin- clavulanate) for co-administration with carbapenems (imipenem- cilastatin and meropenem) PO / IV 250 mg 3× a day p-aminosalicylic acid PO / IV 4 g 2–3× a day i High-dose isoniazid k PO / IV 15 mg/kg daily a Dosages may not apply to patients with severely decreased kidney function, including in the setting of dialysis, for which consultation with a nephrologist is advised. b Levofloxacin doses of up to 1,250 mg have been used safely when needed to achieve therapeutic concentrations. A recent population pharmacokinetic study in South African children found that higher levofloxacin doses from 18 mg/kg/d for younger children, up to 40 mg/kg/d for older children, may be required to achieve adult-equivalent exposures. c Higher moxifloxacin doses have been used safely when the isolate is resistant to ofloxacin and the minimum inhibitory concentration for levofloxacin or moxifloxacin suggests higher doses may overcome resistance. Higher doses also are used in cases of malabsorption. d Cycloserine doses can be divided if needed (typically twice daily). Doses >750 mg are difficult for many patients to tolerate. e Cycloserine dose may be lowered if serum concentrations exceed 35 mg/ml, even if patient is not experiencing toxicity, to prevent central nervous system toxicity. f Modified from adult intermittent dose of 25 mg/kg, and accounting for larger total body water content and faster clearance of injectable drugs in most children. Dosing can be guided by serum concentrations. (cont'd)

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