CS229616_P

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention 

Division of Tuberculosis Elimination

TB Elimination

Treatment of Drug-Susceptible TB Disease 

in Persons Not Infected with HIV

Introduction

Treating tuberculosis (TB) disease benefits not only the individual patient but the community as a whole. 

Thus, any health care provider undertaking treatment of a patient with TB, whether a public health or 

private practitioner, is assuming a public health function that includes the responsibility for not only 

prescribing an appropriate regimen but also ensuring the patient’s adherence to the regimen until 

treatment is completed.

Recommended Regimens

There are 10 drugs currently approved by the U.S. Food and Drug Administration (FDA) for treating TB. 

Of the approved drugs, the first-line anti-TB agents that form the core of treatment regimens include

•	 isoniazid (INH), 

•	 rifampin (RIF), 

•	 ethambutol (EMB), and 

•	 pyrazinamide (PZA). 

Regimens for treating TB disease have an initial phase of 2 months, followed by a choice of several options 

for the continuation phase of either 4 or 7 months. The continuation phase should be extended to 28 

weeks for patients who have cavitation on the initial chest film and positive sputum cultures after 2 

months of treatment. Treatment completion is determined by the number of doses ingested over a given 

period of time. Although basic TB regimens are broadly applicable, there are modifications that should be 

made under special circumstances (i.e., HIV infection, drug resistance, pregnancy, or treatment of children). 

Listed below are the basic regimens; please refer to Treatment of TB1 for all options for the treatment of 

drug-susceptible TB. 

Basic TB Treatment Regimens

Preferred Regimen Alternative Regimen Alternative Regimen

Initial Phase

Daily INH, RIF, PZA, and EMB* 

for 56 doses (8 weeks)

Initial Phase 

Daily INH, RIF, PZA, and EMB* for 14 

doses (2 weeks), then twice weekly 

for 12 doses (6 weeks)

Initial Phase 

Thrice-weekly INH, RIF, PZA, and 

EMB* for 24 doses (8 weeks)

Continuation Phase 

Daily INH and RIF for 126 doses 

(18 weeks) or Twice-weekly INH 

and RIF for 36 doses (18 weeks)

Continuation Phase 

Twice-weekly INH and RIF for 

36 doses (18 weeks)

Continuation Phase

Thrice-weekly INH and RIF for 

54 doses (18 weeks)

*EMB can be discontinued if drug susceptibility studies demonstrate susceptibility to first-line drugs.
May 2012

A continuation phase of once-weekly INH and rifapentine can be used for HIV-negative patients who 

do not have cavities on the chest film and who have negative acid-fast bacilli (AFB) smears at the 

completion of the initial phase of treatment.

Case Management

Patient-centered case management should be used in the treatment strategy with an adherence 

plan that includes directly observed therapy (DOT). DOT is a strategy in which a health care worker or 

another designated person watches the TB patient swallow each dose of the anti-TB drugs. All patients 

taking drugs fewer than 7 days per week (e.g., 1, 2, 3, or 5 days a week) must receive DOT. 

Follow-up Evaluations

Sputum specimens for microscopic examination and culture should be obtained from patients 

diagnosed with TB disease at a minimum of monthly intervals until two consecutive specimens are 

negative on culture. It is critical to obtain a sputum specimen at the end of the initial phase (2 months) 

to determine if the continuation phase should be extended. In addition, it is essential that patients 

have clinical evaluations at least monthly to identify possible adverse effects of the anti-TB medications 

and to assess adherence. All patients with TB disease should have counseling and testing for HIV.

For More Information

1. Centers for Disease Control and Prevention. Treatment of Tuberculosis. MMWR 2003;52(No. RR-11). 

www.cdc.gov/mmwr/PDF/rr/rr5211.pdf

http://www.cdc.gov/tb