Recommendations
| Dosage | Remarks | |
|---|---|---|
|
isoniazid oral 5 mg/kg once daily
+ rifampicin oral 450/600 mg once daily+ pyrazinamide oral 30 mg/kg once daily+ ethambutol oral 20 mg/kg once daily |
Isoniazid: maximum dose 300 mg/24 hours Rifampicin: dose: 600 mg ≥ 50 kg, 450 mg ≤ 50 kg, or optimised dose (35 mg/kg). Indications for optimised dose: large cavity(ies), diabetes, disseminated disease, alcoholism, HIV infection, severe malnutrition and meningitis Pyrazinamide: maximum dose 2000 mg/24 hours Ethambutol: maximum dose 1600 mg/24 hours |
The treatment advice is based on drug-susceptible tuberculosis in patients without renal insufficiency. The treatment regimen depends on, among other things, the molecular and phenotypic susceptibility, the extent and localisation of the tuberculosis and any demonstrable culture conversion. Always consult a tuberculosis specialist for tuberculosis TB protocol (version 5) (umcn.nl)
Routine pyridoxine (vitamin B6) to prevent neuropathy is only necessary in patients with an increased risk of neuropathy: people with alcohol dependence, pregnant and breastfeeding women, elderly patients, people with diabetes, HIV-infected patients, malnourished patients and patients with renal impairment.
Corticosteroids:
The use of corticosteroids as adjunctive therapy in the treatment of drug-susceptible M. tuberculosis is only recommended for pericarditis and tuberculous meningitis
Tuberculous pericarditis
Adults: Week 1 to 4 prednisone 60 mg/day (or an equivalent dose of prednisolone). Weeks 5 to 8 30 mg/day; Weeks 9-10 15 mg/day; Week 11 5 mg/day, then stop.
Tuberculous meningitis
Stage I (GCS 15 without focal neurological signs): Intravenous dexamethasone starting in week 1 at 0.3 mg/kg/day, in week 2 0.2 mg/kg/day, followed by 4 weeks of oral treatment starting in week 3 with 0.1 mg/kg, in week 4 3 mg, in week 5 2 mg, in week 6 1 mg (total 6 weeks) and then stop.
Stage II (GCS 11-14 or focal neurological signs) and III (GCS <11): Intravenous dexamethasone starting in week 1 at 0.4 mg/kg/day, then reducing by 0.1 mg/kg up to and including week 4, followed by 4 weeks of oral treatment starting in week 5 with 4 mg once daily and then reducing by 1 mg each week (total 8 weeks), then stop.
Notifiable disease group B1; report within one working day after diagnosis
For the treatment of children: consult a paediatric infectious diseases specialist