Guideline Clearing House

The National Guideline Clearinghouse™ (NGC) Web site is updated weekly.


http://www.guideline.gov/browse/guideline_index.aspx

KDOQI^™Guidelines and Commentaries

Standards of Medical Care American Diabetes Association

Standards of Medical Care American Diabetes Association

ACC/AHA Joint Guidelines

ACC/AHA Joint Guidelines

Tuberculosis Category and Class

World Health Organization's Recommended First-Line Regimens for Tuberculosis Treatment

TB Category TB Patients TB Treatment Regimens Initial Phase (daily or 3 times weekly) Continuation Phase (daily or 3 times weekly) I New smear positive; new smear negative with extensive chest x-ray abnormalities, severe HIV disease, or severe extrapulmonary TB Isoniazid,* rifampin,** pyrazinamide, ethambutol*** for 2 months Isoniazid* and rifampin** for 4 months Isoniazid and ethambutol† daily for 6 months II Previously treated smear-positive pulmonary TB# relapse return after default treatment failure Isoniazid,* rifampin,** pyrazinamide, ethambutol and streptomycin for 2 months, followed by isoniazid,* rifampin,** pyrazinamide and ethambutol for 1 month Isoniazid,* rifampin,** and ethambutol for 5 months III Smear-negative TB and extrapulmonary TB less severe than category 1## Isoniazid,* rifampin,** pyrazinamide, ethambutol for 2 months Isoniazid* and rifampin** for 2 months Isoniazid* and ethambutol† daily for 6 months IV Chronic and multidrug-resistant TB (smear positive after supervised retreatment) Multidrug-resistant or individualized regimen per country protocol

Source: Harries A, Maher D, Graham S. TB/HIV: A Clinical Manual, 2nd ed . 2004. WHO, Geneva. * Pyridoxine 10 mg daily is added to each dose of isoniazid. ** Rifampin is called rifampicin in other countries. It is recommended that every rifampin dose be supervised (directly observed therapy). Rifampin should not be used with nevirapine or protease inhibitors; rifabutin may be substituted with appropriate dosage adjustments. *** In TB meningitis, the World Health Organization recommends substituting streptomycin for ethambutol. †Isoniazid and ethambutol is expected to have a higher failure rate than isoniazid and rifampin; however, it is included for treatment when continuation-phase therapy cannot be directly supervised, to avoid the risk of promoting resistance to rifampin. # Culture and susceptibility testing (if available) should be performed at the beginning of Category II treatment. ## HIV-infected patients in Category III will take the same treatment as persons in Category I. Classification System for TB Class Type Description 0 No TB exposure Not infected No history of exposure Negative reaction to tuberculin skin test 1 TB exposure No evidence of infection History of exposure Negative reaction to tuberculin skin test 2 TB infection No disease Positive reaction to tuberculin skin test Negative bacteriologic studies (if done) No clinical, bacteriologic, or radiographic evidence of TB 3 TB, clinically active M. tuberculosis cultured (if done) Clinical, bacteriologic, or radiographic evidence of current disease 4 TB Not clinically active History of episode(s) of TB or Abnormal but stable radiographic findings Positive reaction to the tuberculin skin test Negative bacteriologic studies (if done) and No clinical or radiographic evidence of current disease 5 TB suspect Diagnosis pending TB disease should be ruled in or out within 3 months

Tuberculosis Treatment in Resource-Limited Settings