Medicines for people with TB

TB medicines quick reference guide - very useful for health workers (Wits Reproductive Health and HIV Institute)
Our short introduction to TB treatment for activists and patients
How TB drugs work: Photo gallery showing the sites of action for TB medicines (NIAID)

First-line medicines
Multi-Drug Resistant TB medicines
Extremely-Drug Resistant TB medicines
Experimental medicines

First-line medicines

Medicines for people being treated for TB the first time and who do not have multi-drug resistance

The World Health Organisation (2010) recommends that new patients with pulmonary TB should receive the following treatment regimen: two months of isoniazid, rifampicin, ethambutol and pyrazinamide, followed by four months of isoniazid and rifampicin. This is abbreviated as 2HREP/4HR.

For patients being retreated for drug-susceptible TB, the recommended regimen is two months of isoniazid, rifampicin, ethambutol, pyrazinamide and streptomycin followed by one month of isoniazid, rifampicin, ethambutol, pyrazinamide, followed by five months of isoniazid, rifampicin and ethambutol. This is abbreviated as 2HREPS/1HRE/5HRE.

There are nuances for patients with extrapulmonary TB and various other conditions. Consult the WHO guidelines for these.

Medicines for people with multi-drug resistant TB (MDR TB)

Patients who are resistant to isoniazid and rifampicin, the two most important first-line medicines, have MDR TB.

The World Health Organisation (2011) recommends that standard second-line treatment should include 5 drugs: pyrazinamide, a fluoroquinolone, an injectable, ethionamide (or prothionamide) and cycloserine, or else PAS if cycloserine cannot be used. It recommends a mimumum eight months intensive phase treatment (with all five drugs) and a continuous phase (in which the injectable is no longer used). It recommends a minimum of 20 months total treatment.

Treating MDR TB is complicated. The evidence base for the management of the disease is very poor, especially for children. See the WHO guidelines.

Injectables (parenteral agents)

Fluoroquinolones

Oral bacteriostatic

Medicines for people with extensively drug-resistant TB (XDR TB)

Extensively drug resistant TB is defined as MDR TB plus resistance to a fluoroquinolone, and at least one of three injectable second-line (i.e. MDR TB) drugs. Treating XDR-TB is difficult and requires tailored individual care. The following experimental drugs of unknown efficacy may be used:

Experimental medicines

These are new medicines that are still being tested and are not yet approved by regulatory authorities for the treatment of TB.

You can look at the pipeline of new TB medicines at newtbdrugs.org.