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J Microbiol Immunol Infect2004;37:382-384 Guidelines for chemotherapy of tuberculosis in Taiwan
Infectious Diseases Society of the Republic of China; The Society of Tuberculosis, Taiwan; Medical Foundation in Memory of Dr. Deh-Lin Cheng; Foundation of Professor Wei-Chuan Hsieh for Infectious Diseases Research and Education; and CY Lee’s Research Foundation for Pediatric Infectious Tuberculosis is a major health problem in Taiwan 1. Establishment of guidelines from the viewpoint of and worldwide. Despite concerted efforts of health authorities to control tuberculosis, the incidence and 2. Antimicrobial agents recommended in the guidelines prevalence of tuberculosis in Taiwan remains high are agents already marketed in Taiwan.
(64.84/100,000 and 5.56/100,000 in 2001). Most cases 3. Guidelines were based on academic principles rather of tuberculosis are now seen and treated by primary than the regulations of the Bureau of National Health A consensus meeting was convened on March 10, Many recommendations were based on expert 2004 to establish guidelines for the chemotherapy of opinion and unpublished data, due to the lack of tuberculosis. This was preceded by a collaborative randomized, controlled, clinical trials in the area. Topics symposium on tuberculosis held by the Infectious not included in the scope of these guidelines are: Diseases Society of the Republic of China (IDSROC), treatment of TB-human immunodeficiency virus (HIV) the Medical Foundation in Memory of Dr. Deh-Lin coinfection, drug-drug interactions, several anti- Cheng, Foundation of Professor Wei-Chuan Hsieh tuberculous drugs (rifabutin, cycloserine) and treatment for Infectious Diseases Research and Education, and CY Lee’s Research Foundation for Pediatric Infectious This guideline was approved by the board of IDSROC, Diseases and Vaccines. Participants of the consensus and a copy will be sent to primary care physicians, the meeting included board members of the IDSROC, and setting where most cases of tuberculosis are treated. The experts in infectious diseases, chest medicine, and document is published in the Journal of Microbiology, tuberculosis.* Three principles were maintained in Immunology and Infection, to serve as an easily accessible reference to all practising physicians in Taiwan.
Guidelines for chemotherapy of tuberculosis Pulmonary tuberculosis
Drugs of choice
I. New case
then INH + RIF + EMB for 4 monthsa then Rifinahc + EMB for 4 monthsa II. Retreatmentd
INH + RIF + EMB + PZA + IAf for 3 months, INH + RIF + EMB + PZA + IAf for 3 months, INH + RIF + EMB + PZA + IAf for 3 months, III. Drug resistance
RIF + EMB + PZA + IAf for 6 months INH + EMB + PZA + IAf ± FQifor 9 months EMB + PZA + TBN + IAf + FQi PZA + TBN + PAS + IAf + FQi IV. Intolerance
INH + EMB + PZA + IAf for 9 months EMB + PZA + TBN + IAf + FQi V. Special situations
RIF + EMB + IAf + FQi for 12-18 months EMB + TBN + IAf + FQi for 18-24 months INH + RIF + EMBl + PZAl for 2 months, then INH + RIF + EMBl for 4 months then INH + RIF + EMB for 4 monthsm Extra-pulmonary tuberculosis
Drugs of choice
Dosage of anti-tuberculous agents (for adults only)
Rifater (INH 80 mg + RIF 120 mg + PZA 250 mg ) 15-20 mg/kg BW, divided to bid-tid (maximum 1 g) Abbreviations: INH = isoniazid; RIF = rifampin; EMB = ethambutol; PZA = pyrazinamide; IA = injectable aminoglycosides; FQ = fluoroquinolones; MDR-TB = multi-drug resistant Mycobacterium tuberculosis; TBN = prothionamide; PAS = para-aminosalicylic acid; ESRD = end-stage renal disease; CNS = central nervous system; BW = body weight; qd = once daily; bid = twice a day; tiw = 3 times weekly; tid = 3 times a day; qid = 4 times a day; qod = once every other day; tab = tablet(s); Ccr = creatinine clearance aCavitation on initial chest X-ray and/or positive cultures at completion of initial 2 months’ treatment, extend treatment to 9 months.
bDose of Rifater is 1 tab/10 kg BW qd, maximum 5 tab.
cDose of Rifinah-300 is 2 tab qd for patients with BW >50 kg, and Rifinah-150 3 tab qd if BW <50 kg.
dCulture and susceptibility testing should be done immediately and regimen should be tailored to susceptibility testing results. Referral to specialists in infectious diseases, chest medicine or experts on tuberculosis is recommended.
eRelapse is defined as a patient who develops active tuberculosis (by culture, clinical or radiological deterioration) after completion of fInjectable aminoglycosides include streptomycin, kanamycin, and amikacin, and should be administered in the initial 2 months of gDefault is defined as interruptions in therapy of longer than 2 months.
hFailure is defined as continued or recurrent positive cultures after 4 months of treatment in patients with assured adherence to the prescribed anti-tuberculous regimen.
iFluoroquinolones include ofloxacin, ciprofloxacin and levofloxacin.
jTreatment duration is a total of 18 months after sputum conversion.
kRenal function impairment is defined as Ccr ≤30 mL/min.
lDoses should be reduced to EMB 15-25 mg/kg BW qod and PZA 12-25 mg/kg BW qd.
mIntermittent (3 times weekly) dosing after hemodialysis is INH 900 mg, RIF 600 mg, EMB 15-25 mg/kg BW and PZA 25-35 mg/kg BW.
nSteroids are recommended (prednisolone <1 mg/kg BW qd or equivalent) for a minimum of 3 weeks.
Consensus Conference Participants (in alphabetical order):
Feng-Yee Chang, Shan-Chwen Chang, Yao-Shen Chen, Yee-Chun Chen, Chen-Yuan Chiang, I-Hsin Chiang,
Ming-Yuan Chou, Mong-Ling Chu, Yin-Ching Chuang, Szu-Min Hsieh, Wei-Chuan Hsieh, Po-Ren Hsueh,
Bor-Shen Hu, Fu-Yuan Huang, Li-Min Huang, Kun-Yen Huang, Kao-Pin Hwang, Chi-Kin Lan, Yeu-Jun
Lau, Chin-Yun Lee, Chun-Ming Lee, Susan Shin-Jung Lee, Hsieh-Shong Leu, Tzou-Yien Lin, Cheng-Yi Liu,
Ching-Chuan Liu, Yung-Ching Liu, Kwen-Tay Luh, Jen Suo, Hung-Chin Tsai, Lih-Shinn Wang, Shue-Ren
Wann, Wing-Wai Wong, Yi-Chun Wu, Muh-Yong Yen


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