Recommended Tuberculosis treatment guidelines

The Center for Disease Control and Prevention, the American Thoracic Society, and the Infectious Diseases Society of America (Centers for Disease Control and Prevention [CDC], 2003) recommends a 2-month chemotherapy of isoniazid, rifampin, pyrazinamide, and ethambutol for the treatment of Tuberculosis followed by a 4-month continuation phase of isoniazid and rifampin. The CDC also added that those who are on antivirals for HIV infection seek care from a healthcare provider who is experienced in treating patients with HIV/TB co-infections due to the two diseases' numerous drug interactions and disease dynamics. Below are flow diagrams of the guideline recommendations (click on images),


Similarly Washington State Department of Health (Washington State Department of Health [DOH], 2009) recommend 2 months phase of isoniazid, rifampin, pyrazinamide, and ethambutol followed by a 4-month continuation phase of isoniazid and rifampin. Below is a flow diagram I made that represents DOH's TB treatment recommendation (click on image),

While on TB treatment therapy, the side effects that are most important to monitor are liver function, hypersensitivity, malaise, headache, fatigue, loss of appetite, dizziness, numbness, tingling, decline in visual acuity (with Ethambutol), blood disorders such as blood in urine and increase bruising (with Rifampin), and of course drug interactions!

As you could see from the flow diagrams, managing TB can be quite complicated due to the complexity of the disease. As a nursing student whose focus area is in infectious disease and who is interested in refugee/immigrant health, I feel a sense of pressure to understand and memorize these guidelines in order to provide quality nursing care to my future TB patients.

Centers for Disease Control and Prevention. (2003). MMWR weekly report: Treatment of Tuberculosis. American Thoracic Society, CDC, and Infectious Diseases Society of America. Retrieved November 2, 2009 from http://www.cdc.gov/mmwr/PDF/rr/rr5211.pdf

Washington State Department of Health. (2009). Washington State: Tuberculosis Service Manual (DOH Publication No. 373-071). Retrieved from
http://www.doh.wa.gov/cfh/TB/Manual/Sections/CompleteManual.pdf