Sandbox/ammth

Dosing Frequency and the Level Of Evidence

Dosing Frequency for New TB Adult Patients with Active Tuberculosis caused by Drug-Susceptible Organisms Optimal first line ▸ Initial Phase: Daily ▸ Continuation Phase: Daily Alternative line in DOT ▸ Initial Phase: Daily ▸ Continuation Phase: Three times a week Alternative line accepted in limited situations † ▸ Initial Phase: Three times a week ▸ Continuation Phase: Three times a week

The level of evidence of the dosage frequency came from the systematic review showed that equivalent efficacy of daily intensive-phase dosing followed by two times weekly continuation phase, however twice weekly dosing is not recommended on operational grounds. Also showed that the daily (rather than three times weekly) intensive-phase dosing may also help to prevent acquired drug resistance in TB patients starting treatment with isoniazid resistance. The systematic review found that patients with isoniazid resistance treated with a three times weekly intensive phase had significantly higher risks of failure and acquired drug resistance than those treated with daily dosing during the intensive phase.

Standard regimens for new TB patients (with presumed, or known, to have drug-susceptible TB)

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)

Isoniazid (INH) rifampin (RIF) ethambutol (EMB) pyrazinamide (PZA)

DOT; Direct Observed Therapy

† if patient is getting DOT and not living with HIV infected patient or HIV prevalent setting