Susceptibility testing of initial isolates should always be obtained. Dosage Recommendation for the Initial Treatment of Tuberculosis in Children and Adults . However, ethambutol should be considered for all children with organisms resistant to other drugs when susceptibility to ethambutol has been demonstrated or suspecitibility is likely. In areas where the prevalence of drug-resistant isolates is less than 4 percent, the fourth drug may be omitted.
Intermittent regimens are well tolerated and equally effective as daily regimens.
Several recent studies have demonstrated that DOT is more effective than self-administered therapy, and results in lower rates of relapse, emergence of drug resistance, and, in HIV seropositive patients, death. Treatment of tuberculosis in patients with HIV infection is extremely effective when begun promptly. 1 Early mortality from untreated or undertreated tuberculosis has ranged from 5 to 18 percent of patients in various series. Moreover, therapy given under direct supervision is associated with better outcomes and longer survival. Patients should be monitored during therapy for compliance, treatment response, development of toxicity, and signs of treatment failure.