Health Professional Platform
TB Learning Hub
Drug-susceptible tuberculosis treatment regimens
4HP Regimen
Isoniazid + Rifapentine daily for 4 months. WHO-preferred shorter regimen for eligible adults & adolescents with DS pulmonary TB without HIV.
6-month 2HRZE/4HR
Standard first-line: 2 months H+R+Z+E, then 4 months H+R. Universally recommended when 4HP not suitable.
Pediatric TB
Child-friendly formulations available. Dosing by weight bands. 4HP now recommended for children ≥2 years.
Multidrug-resistant and rifampicin-resistant TB regimens
BPaLM (6 months)
Bedaquiline + Pretomanid + Linezolid + Moxifloxacin. WHO-recommended for MDR/RR-TB ≥14 years without fluoroquinolone resistance.
BPaL (6 months)
Bedaquiline + Pretomanid + Linezolid. Alternative when moxifloxacin resistance confirmed.
Longer Regimen (9-18 months)
Individualized all-oral regimen for patients not eligible for BPaLM, extensive disease, or additional resistance.
Current WHO-recommended diagnostic tools
Xpert MTB/RIF Ultra
Molecular test, simultaneous TB + rifampicin resistance detection. WHO-recommended initial test. Results in ~2 hours.
Line Probe Assay (LPA)
First-line for H+R resistance; second-line for fluoroquinolone + injectable resistance.
Smear Microscopy
Lower sensitivity, but useful for monitoring treatment response in high-burden settings.
Chest X-ray (CAD)
Computer-aided detection now recommended as triage tool — rapid, non-invasive screening.
Management of TB in people living with HIV
ART for all
All TB-HIV co-infected patients should receive ART regardless of CD4 count. Start within 2 weeks of TB treatment for CD4 <50.
TPT (TB Preventive Treatment)
All PLHIV should be screened for TB; if no active disease, start TPT. 3HP preferred.
Drug Interactions
Rifampicin reduces many ARV drug levels. Avoid nevirapine + dolutegravir double-dose issues. Consult WHO interaction table.
Regimens for TB infection (LTBI) treatment
3HP (3 months)
Weekly Isoniazid + Rifapentine for 3 months (12 doses). WHO-preferred — shorter, better adherence.
4R (4 months)
Daily Rifampicin for 4 months. Good alternative, fewer hepatic events than 6H.
6H (6 months)
Daily Isoniazid for 6 months. Traditional option, still used in many programs.
1HP (1 month)
Daily Isoniazid + Rifapentine for 4 weeks (28 doses). Newest option for PLHIV ≥13 years.
Monitoring and managing TB drug side effects
Hepatotoxicity
Monitor LFTs. Stop if ALT >3× ULN with symptoms or >5× ULN without symptoms. Reintroduce sequentially.
Visual Toxicity
Ethambutol can cause optic neuritis. Baseline visual acuity; red-green color vision. Monthly screening.
Peripheral Neuropathy
Isoniazid-induced. Co-administer pyridoxine (B6) 25-50 mg/day.
Bedaquiline QT
ECG monitoring required. QTc >450ms or increase >60ms from baseline — consult specialist.