Current tuberculosis treatment regimens. Choosing the right one for your patient.

This article has reviewed the use and adverse effects of available first-line and second-line antituberculosis drugs. Treatment regimens consisting of combinations of isoniazid, rifampin, pyrazinamide, streptomycin, and ethambutol will be sufficient in the majority of patients with tuberculosis. The rationale for use of short-course chemotherapy for tuberculosis is based on extensive worldwide experience. The clinical trials that provide the evidence to support the use of ATS/CDC-recommended 6- and 9-month chemotherapeutic regimens have been summarized with attention to the reported relapse rates. Alternative regimens are acceptable in patients who have adverse reactions or resistance to isoniazid and rifampin. Management of patients after starting chemotherapy for tuberculosis requires monitoring for adverse effects, ensuring adherence to therapy and evaluation of response to chemotherapy by documenting bacteriologic conversion. Extrapulmonary tuberculosis responds to the same chemotherapy regimens recommended for pulmonary disease, and corticosteroids are indicated in some forms.