Patient handout

Tuberculosis (active drug-susceptible, MDR-TB, LTBI)

PRODUCTION

1. Your condition

This handout is for tuberculosis (active drug-susceptible, mdr-tb, ltbi). Your care team identified this based on: cough ≥2 weeks + weight loss + drenching night sweats + fever ± hemoptysis — who 4-symptom screen (sens ~70-90% for active pulmonary tb; lower in hiv) (who tb module 4 2022).

Other reasons your team may use this plan: upper-lobe / apical / cavitary / miliary infiltrate on cxr or ct — cavitation raises pretest probability and predicts relapse (ats/cdc/idsa 2016 pmid 27516382); positive xpert mtb/rif ultra or afb smear / mycobacterial culture from sputum — xpert ultra overall sens ~88% vs culture (dorman lancet id 2018 pmid 29198911); close contact with infectious tb or birth/extended residence in a high-burden country — sets the pretest prior (cdc ltbi 2020).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
isoniazid	5 mg/kg PO daily (max 300 mg)	PO	daily × 6 months (intensive + continuation)	Early-bactericidal backbone. Hepatotoxicity + dose-dependent peripheral neuropathy (pyridoxine MANDATORY). RxCUI corrected 1011→6038 RxNav-verified IN 2026-05-16 (1011 was anti-thymocyte globulin — SAFETY-CRITICAL) (ATS/CDC/IDSA 2016 PMID 27516382)
rifampin	10 mg/kg PO daily (max 600 mg)	PO	daily on empty stomach × 6 months	Sterilising backbone enabling the 6-month course. STRONG CYP3A4/P-gp inducer — collapses PI/NNRTI, DOAC, warfarin, hormonal-contraceptive, methadone, azole, steroid levels; substitute rifabutin (RxCUI 55672) for PI-based ART. Orange body fluids — counsel. RxCUI 9384 RxNav-verified IN 2026-05-16
pyrazinamide	25 mg/kg PO daily (max 2000 mg)	PO	daily × 2 months (intensive phase only)	Sterilising in the acidic intracellular milieu — its 2-month use is what permits a 6-month total. Hepatotoxic; hyperuricemia/arthralgia; renal interval-extension to 3×/week if CrCl <30. RxCUI 8987 RxNav-verified IN 2026-05-16
ethambutol	15-25 mg/kg PO daily	PO	daily × 2 months (until pan-susceptibility confirmed)	Companion drug preventing resistance amplification until INH/RIF susceptibility confirmed — DROP once DST shows full susceptibility. Dose-dependent optic neuritis — baseline + monthly Snellen/Ishihara; renal interval-extension if CrCl <30. RxCUI 4110 RxNav-verified IN 2026-05-16
pyridoxine	25-50 mg PO daily	PO	daily for the entire INH-containing course	MANDATORY with INH to prevent peripheral neuropathy — risk amplified in diabetes, HIV, alcohol, pregnancy, malnutrition, CKD. RxCUI 684879 RxNav-verified IN 2026-05-16

Plan: TB treatment by phenotype — DS-TB 6-month (2HRZE/4HR) vs 4-month rifapentine-moxifloxacin (Study 31) vs LTBI (3HP/4R/3HR/9H); DR-TB routed to id.tb_drug_resistant.v1

3. Your action plan

Use these zones to know what to do based on how you feel.

GREEN — On track — taking every dose, no toxicity, sputum converting

If you have:

Taking medication every dose with DOT
No new symptoms (jaundice, vision change, foot numbness, severe nausea)
Sputum becoming smear-negative on schedule

Do this:

Continue all medications as prescribed — even a few missed doses can drive resistance
Attend all DOT visits and lab appointments
Take pyridoxine (B6) every day if on isoniazid
Wear a mask in public until your provider clears you

YELLOW — Caution — early side effects or missed doses

If you have:

New mild nausea, appetite loss, joint pain (PZA), pins-and-needles in the feet (neuropathy)
Reddish/orange tears, urine, sweat (rifampin — expected; confirm with provider)
Mild rash; missed 1-2 doses

Do this:

Call your provider or DOT nurse the same day
Do not stop medication on your own — your provider will adjust
Increase pyridoxine to 50 mg daily if foot numbness
Bring a current medication + supplement list to the next visit

Call your provider if:

Missed >2 doses
New symptoms persisting >24 h
Rash spreading or with fever

RED — Medical alert — drug toxicity or worsening TB

If you have:

Yellow eyes/skin (jaundice), dark urine, severe nausea/vomiting/abdominal pain
Vision change — blurring, decreased acuity, red-green colour change (possible ethambutol toxicity)
Worsening cough/breathlessness/fevers despite weeks of therapy
Coughing up blood (hemoptysis)
New seizures / confusion / severe headache

Do this:

STOP medication and call your provider / DOT nurse immediately
Go to the emergency department for jaundice, hemoptysis, vision change, severe abdominal pain, or new neurologic symptoms
Bring all medication bottles with you
Do not restart until cleared by your provider

Call your provider if:

Any red-zone symptom — emergency department now, do not wait

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Xpert MTB/RIF Ultra POSITIVE, rifampin-SUSCEPTIBLE, in a patient with a high pretest prior (TB symptoms + endemic origin/exposure ± HIV) — Xpert Ultra overall sens ~88% vs culture (smear-neg-culture-pos ~63%, HIV+ ~90%), specificity ~96%
Xpert MTB/RIF Ultra reports RIFAMPIN RESISTANCE, OR DST confirms INH+RIF resistance, OR contact with a known MDR/pre-XDR case
ALT >3× ULN with symptoms (nausea, RUQ pain, jaundice) OR ALT >5× ULN asymptomatic on a TB regimen
Decreased visual acuity / red-green colour deficit / central scotoma on ethambutol
Sputum culture POSITIVE at month 2 on a standard regimen (especially with baseline cavitation)
CSF / imaging consistent with TB meningitis OR miliary/disseminated TB(life-threatening)

5. Follow-up

End-of-treatment CURE assessment per WHO/ATS (clinical + microbiological — culture-negative at end of therapy; treatment completed if doses verified). Close-contact investigation → IGRA/TST + symptom screen + LTBI evaluation/treatment. Mandatory public-health reporting and case closure. Adherence/relapse education; relapse usually within 6-12 mo (highest if cavitary + positive month-2 culture). Long-term follow-up for late toxicity and post-TB lung function (ATS/CDC/IDSA 2016 PMID 27516382; CDC LTBI 2020)

6. Sources

Guideline: WHO Consolidated Guidelines on TB Module 4: Treatment — drug-susceptible TB & patient care (2022) + ATS/CDC/IDSA Treatment of Drug-Susceptible Tuberculosis (Nahid CID 2016; PMID 27516382) + CDC 2022 4-month rifapentine-moxifloxacin update (Study 31/A5349) + CDC/NTCA LTBI Treatment Guidelines 2020 + WHO LTBI consolidated guidelines 2024