Tuberculosis — Uganda (General Adult population)
First-Line Regimen (Susceptible TB - Pulmonary/Extrapulmonary)
Excluding TB meningitis/Bone TB. Intensive phase: 2RHZE (2 months). Continuation phase: 4RH (4 months). R=Rifampicin, H=Isoniazid, Z=Pyrazinamide, E=Ethambutol. CAUTION: Rifampicin reduces oral contraceptive efficacy (use barrier method).
TB Meningitis and Bone (Osteoarticular) TB
Intensive phase: 2RHZE. Continuation phase: 10RH (Total 12 months).
Alternative 4-Month Regimen (Adults >12 yrs, >40kg, HIV+ CD4>100)
Intensive: 2 HPMZ. Continuation: 2 HPM. (H=Isoniazid, P=Rifapentine, M=Moxifloxacin, Z=Pyrazinamide).
Drug-Resistant TB (MDR/RR-TB)
Patients with Rifampicin resistance MUST be treated with second-line regimens at designated MDR-TB treatment initiation centers in consultation with the national panel. INH mono-resistance: 6(H)REZ-levofloxacin.
Adjunctive Therapy
Vitamin B6 (Pyridoxine) 25 mg/day given concomitantly with Isoniazid to prevent peripheral neuropathy. Prednisolone (1-2 mg/kg, max 60mg/day for 4 weeks then tapered over 2 weeks) for TB meningitis/severe inflammation.
Side Effect Management: GI / Joint Pains
Low appetite/nausea: Give drugs with small meal or before bed. Joint pains (Pyrazinamide): Give analgesic (Ibuprofen or Paracetamol). Orange/red urine (Rifampicin): Reassure patient it is harmless.
Side Effect Management: Hepatitis / Jaundice
Jaundice/liver failure (Isoniazid, Pyrazinamide, Rifampicin): Stop all drugs immediately. Manage supportively. When resolved, re-introduce single drugs at 3-7 days interval, starting from least likely involved.
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