4
Treatment
Organization and Supervision of Treatment
See page 22 for explanation of Recommendation Grading.
➤ Recommendation 1: The panel suggests using case management
interventions during treatment of patients with tuberculosis (C-VL).
➤ Recommendation 2: The panel suggests using DOT rather than SAT
for routine treatment of patients with all forms of tuberculosis (C-L).
Recommended Treatment Regimens
➤ Recommendation 3a: The panel recommends the use of daily rather
than intermittent dosing in the intensive phase of therapy for drug
susceptible pulmonary tuberculosis (S-M).
➤ Recommendation 3b: Use of thrice-weekly therapy in the intensive
phase (with or without an initial 2 weeks of daily therapy) may be
considered in patients who are not HIV infected and are also at low
risk of relapse (pulmonary tuberculosis caused by drug-susceptible
organisms, that at the start of treatment is non-cavitary and/or smear
negative) (C-L).
➤ Recommendation 3c: In situations where daily or thrice-weekly DOT
therapy is difficult to achieve, use of twice-weekly therapy after an
initial 2 weeks of daily therapy may be considered for patients who
are not HIV-infected and are also at low risk of relapse (pulmonary
tuberculosis caused by drug-susceptible organisms, that at the start
of treatment is non-cavitary and/or smear negative) (C-VL).
Note: If doses are missed in a regimen using twice-weekly dosing, then therapy is
equivalent to once weekly, which is inferior (See below).
➤ Recommendation 4a: The panel recommends the use of daily or
thrice weekly dosing in the continuation phase of therapy for drug
susceptible pulmonary tuberculosis (S-M).
➤ Recommendation 4b: If intermittent therapy is to be administered in
the continuation phase, then the panel suggests use of thrice-weekly
instead of twice-weekly therapy (C-L).
This recommendation allows for the possibility of some doses being missed. With twice-
weekly therapy, if doses are missed then therapy is equivalent to once weekly, which is
inferior.
➤ Recommendation 4c: The panel recommends against use of once-
weekly therapy with INH 900 mg and rifapentine 600 mg in the
continuation phase (S-H).
In uncommon situations where more than once-weekly DOT is difficult to achieve,
once-weekly continuation phase therapy with INH 900 mg plus rifapentine 600 mg
may be considered for use only in HIV-uninfected persons without cavitation on chest
radiography.
