Drug | Adult dose* | Pediatric dose¶ |
IsoniazidΔ | 5 mg/kg (usual maximum dose 300 mg) | 10 to 15 mg/kg per day |
Rifampin (rifampicin)◊ | 10 mg/kg (usual maximum dose 600 mg) | 20 to 30 mg/kg per day |
Rifabutin◊ | 5 mg/kg (usual maximum dose 300 mg) | -- |
Pyrazinamide§ | Patient weight 40 to 55 kg¥:
| 30 to 40 mg/kg per day |
Patient weight 56 to 75 kg¥:
| ||
Patient weight 76 to 90 kg¥‡:
| ||
Ethambutol** | Patient weight 40 to 55 kg¥:
| 15 to 25 mg/kg per day |
Patient weight 56 to 75 kg¥:
| ||
Patient weight 76 to 90 kg¥:
| ||
Ethionamide | -- | 15 to 20 mg/kg per day in 2 or 3 divided doses |
Amikacin | -- | 15 to 20 mg/kg per day |
Levofloxacin | 15 to 20 mg/kg per day |
CNS: central nervous system.
* Adult dosing listed in this table is used in patients ≥15 years old or >40 kg. Dosing based on actual weight is acceptable in patients who are not obese. For obese patients (>20% above ideal body weight [IBW]), dosing based on IBW may be preferred for initial doses. Some clinicians prefer a modified IBW (IBW + [0.40 × (actual weight − IBW)]) as is done for initial aminoglycoside doses. Because tuberculosis drug dosing for obese patients has not been established, therapeutic drug monitoring may be considered for such patients.
¶ For empiric treatment of CNS TB (not known or suspected to be drug resistant) in children, we are in agreement with the American Academy of Pediatrics, which recommends treatment with an intensive phase 4-drug regimen consisting of isoniazid, rifampin, pyrazinamide, and ethionamide or levofloxacin (in place of ethambutol, given its poor CNS penetration) administered daily for 2 months.
Δ Pyridoxine (vitamin B6; 25 to 50 mg/day) is given with isoniazid to individuals at risk for neuropathy (eg, pregnant women, breastfeeding infants, and individuals with HIV infection, diabetes, alcoholism, malnutrition, chronic renal failure, or advanced age). For patients with peripheral neuropathy, experts recommend increasing pyridoxine dose to 100 mg/day.
◊ Rifabutin dose may need to be adjusted when there is concomitant use of protease inhibitors or nonnucleoside reverse transcriptase inhibitors. Refer to the UpToDate topic on treatment of pulmonary tuberculosis in HIV-infected adults for specific dose adjustments.
§ For patients with creatinine clearance <30 mL/min (by Cockroft-Gault equation) or for patients receiving intermittent hemodialysis, pyrazinamide dosing consists of 25 to 35 mg/kg (ideal body weight) per dose orally 3 times per week (not daily); max 2.5 g per dose. On the day of hemodialysis, medications should be administered after hemodialysis. Monitoring of serum drug concentrations should be considered to ensure adequate drug absorption without excessive accumulation and to assist in avoiding toxicity.
¥ Based on estimated lean body weight.
‡ Patients >90 kg should have serum concentration monitoring. In obese patients, weight-based dosing is likely best based on measurements of ideal (versus total) body weight.
† Maximum dose regardless of weight.
** For patients with creatinine clearance <30 mL/min (by Cockroft-Gault equation) or for patients receiving intermittent hemodialysis, ethambutol dosing consists of 20 to 25 mg/kg (ideal body weight) per dose orally 3 times per week (not daily); max 1.6 g per dose. On the day of hemodialysis, medications should be administered after hemodialysis. Monitoring of serum drug concentrations should be considered to ensure adequate drug absorption without excessive accumulation and to assist in avoiding toxicity.Do you want to add Medilib to your home screen?