15
Shading around boxes indicates activities that are optional or contingent on other
information.
1
Obtain sputa for smear and culture at baseline, then monthly until 2 consecutive
specimens are negative. Collecting sputa more often early in treatment for assessment
of treatment response and at end of treatment is optional. At least one baseline
specimen should be tested using a rapid molecular test.
2
Drug susceptibility for isoniazid, rifampin, ethambutol (EMB), and pyrazinamide
should be obtained. Repeat drug susceptibility testing if patient remains culture
positive after completing 3 months of treatment. Molecular resistance testing should
be performed for patients with risk for drug resistance.
3
Obtain chest radiograph at baseline for all patients, and also at month 2 if baseline
cultures are negative. End-of-treatment chest radiograph is optional. Other imaging
for monitoring of extrapulmonary disease.
4
Monitor weight monthly to assess response to treatment; adjust medication dose if
needed.
5
Assess adherence and monitor improvement in tuberculosis symptoms (eg, cough,
fever, fatigue, night sweats) as well as development of medication adverse effects
(eg, jaundice, dark urine, nausea, vomiting, abdominal pain, fever, rash, anorexia,
malaise, neuropathy, arthralgias).
6
Patients on EMB: baseline visual acuity (Snellen test) and color discrimination
tests, followed by monthly inquiry about visual disturbance and monthly color
discrimination tests.
7
Liver function tests only at baseline unless there were abnormalities at baseline,
symptoms consistent with hepatotoxicity develop, or for patients who chronically
consume alcohol, take other potentially hepatotoxic medications, or have viral
hepatitis or history of liver disease, human immunodeficiency virus (HIV) infection,
or prior drug-induced liver injury.
8
Baseline for all patients. Further monitoring if there are baseline abnormalities or as
clinically indicated.
9
HIV testing in all patients. CD4 lymphocyte count and HIV RNA load if positive.
10
Patients with hepatitis B or C risk factor (eg, injection drug use, birth in Asia or
Africa, or HIV infection) should have screening tests for these viruses.
11
Fasting glucose or hemoglobin A1c for patients with risk factors for diabetes
according to the American Diabetes Association including : age >45 years, body mass
index >25 kg/m
2
, first-degree relative with diabetes, and race/ethnicity of African
American, Asian, Hispanic, American Indian/Alaska Native, or Hawaiian Native/
Pacific Islander.
Figure 2. Baseline And Follow-Up Evaluations For Patients
Treated With First-Line Tuberculosis Medications
Footnotes
