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

Division of Tuberculosis Elimination

TB Elimination

General Considerations for 

Treatment of TB Disease

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 are

• isoniazid (INH),

• rifampin (RIF),

• ethambutol (EMB), and

• pyrazinamide (PZA).

Regimens for treating TB disease have an intensive phase of 2 months, followed by a 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

Intensive Phase 

Daily INH, RIF, PZA, and 

EMB* for 40-56 doses** (8 

weeks)

Intensive Phase 

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

doses (2 weeks), then three-timesweekly for 18 doses (6 weeks)

Intensive Phase 

Three-times-weekly INH, RIF, 

PZA, and EMB* for 24 doses (8 

weeks)

Continuation Phase 

Daily INH and RIF for 90-126 

doses** (18 weeks) or three-times 

weekly INH and RIF for 54 doses 

(18 weeks)

Continuation Phase 

Three-times-weekly INH and 

RIF for 54 doses (18 weeks)

Continuation Phase 

Three-times-weekly INH and 

RIF for 54 doses (18 weeks)

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

** Guidelines allow dosing 5 or 7 days-a-week; 5 days-a-week administration by DOT is an acceptable alternative to 7 days- 

 a-week administration.
August 2016

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 intensive 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 intensive 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.

1. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases

Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis. Clin Infect

Dis. (2016). Available online at http://cid.oxfordjournals.org/content/63/7/e147

2. Special Considerations for Treatment of TB Disease in Persons Infected with HIV (Fact Sheet). Available

online at http://www.cdc.gov/tb/publications/factsheets/treatment.htm 

http://www.cdc.gov/tb

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