The analysis of the primary outcome was repeated in the per-protocol population, which did not include patients with unlikely tuberculous meningitis or an alternative diagnosis according to the diagnostic criteria,From April 18, 2011, through June 18, 2014, a total of 817 adult patients were randomly assigned to receive standard antituberculosis treatment plus either placebo (409 patients; standard-treatment group) or additional rifampin and levofloxacin (408 patients; intensified-treatment group). Repeat cultures should be performed after the initial eight-week treatment. Isoniazid (INH), rifampin (Rifadin), ethambutol (Myambutol), and pyrazinamide are first-line therapies.The decision to initiate treatment is based on clinical suspicion of disease; physicians should not necessarily await the results of cultures or smears before beginning treatment Isoniazid (INH), rifampin (Rifadin), pyrazinamide, ethambutol (Myambutol)Once daily for 2 weeks, then twice weekly for 6 weeks (26 doses)Isoniazid (INH), rifampin (Rifadin), pyrazinamide, ethambutol (Myambutol)Once daily for 2 weeks, then twice weekly for 6 weeks (26 doses)Treatment algorithm for patients with possible tuberculosis infection.Treatment algorithm for patients with possible tuberculosis infection.Four regimens are recommended for patients without drug-resistant tuberculosis Tablets (50, 100, and 300 mg), elixir (50 mg per 5 mL), aqueous solution for IV or IM injection (100 mg per mL)20 to 30 mg per kg per dose (up to 900 mg per dose)Capsules (150 and 300 mg; powder may be suspended for oral administration), aqueous solution for IV injection10 to 20 mg per kg per dose (up to 600 mg per dose)Tablets (50, 100, and 300 mg), elixir (50 mg per 5 mL), aqueous solution for IV or IM injection (100 mg per mL)20 to 30 mg per kg per dose (up to 900 mg per dose)Capsules (150 and 300 mg; powder may be suspended for oral administration), aqueous solution for IV injection10 to 20 mg per kg per dose (up to 600 mg per dose)The initial eight-week phase of each regimen includes four agents to cover drug-resistant strains of Three groups of patients should receive 31 weeks of continuation therapy: those with drug-susceptible cavitary pulmonary tuberculosis and positive sputum cultures at the completion of the initial phase; those whose initiation phase did not include pyrazinamide; and those who received once-weekly isoniazid and rifapentine during the initiation phase of treatment and had a positive sputum culture at the end of the initiation phase.Drug resistance is more likely in patients whose therapy is interrupted early in the course of treatment or who spend a significant amount of time off the medication.Several potential drug interactions are associated with the medications used for treatment of tuberculosis, most notably, the rifamycin drugs.Medications for tuberculosis treatment should be administered together.Isoniazid, rifampin, and pyrazinamide may cause drug-induced hepatitis, defined as five times the upper limit of normal serum aspartate transaminase (AST) in asymptomatic patients or three times the upper limit of normal in symptomatic patients.

Ending neglect: the elimination of tuberculosis in the United States. ), Pham Ngoc Thach Hospital for Tuberculosis and Lung Disease (N.D.B., N.H.D., N.T.N.L., N.H.L., N.N.L., L.T.P., N.N.V., N.Q.H., N.T.B.Y., D.T.M.H. and the Global Alliance for TB Drug Development (a public-private entity developing new drugs and regimens for TB treatment).

If pyrazinamide is not included in the initiation phase of treatment, a minimum of nine months of treatment is recommended.Breastfeeding is not contraindicated during treatment for tuberculosis. Among the patients who were confirmed to have a condition other than tuberculous meningitis, in the standard-treatment group, four had cryptococcal meningitis and one had an intracranial tumor; in the intensified-treatment group, seven had cryptococcal meningitis, one had encephalitis caused by herpes simplex virus, and one had eosinophilic meningitis.A total of 121 patients (59 in the standard-treatment group and 62 in the intensified-treatment group) were not included in the per-protocol population.

— all in Ho Chi Minh City, Vietnam; and the Nuffield Department of Medicine, University of Oxford, Oxford (A.D.H., J.N.D., L.M., M.W., G.E.T., J.J.F.

The treatment of multidrug- and rifampin-resistant tuberculosis (MDR/RR TB) is complex.

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