This protocol applies when a patient with pulmonary tuberculosis has not met the required goals of the standard 6-month first-line regimen (2HRZE/4HR — isoniazid, rifampicin, pyrazinamide, and ethambutol). Escalation is warranted when the prior treatment fails to achieve conversion of the sputum culture to negative, or when classic TB symptoms — cough, sputum production, fever, and weight loss — do not improve within the expected timeframe of the first 1–2 months of treatment.
The primary target for this next-step protocol remains conversion of the sputum culture to negative — confirming microbiological clearance of the infection.
When the first-line regimen has not achieved the required targets, management shifts to a drug-resistant TB strategy. The specific regimen is determined by drug susceptibility testing results. The complete structured regimen — including all options and their sequencing — is available in the full protocol.