Pulmonary tuberculosis
ICD-10 A15.0 · ICD-11 1B10

Treatment of Pulmonary TB with Confirmed Isoniazid Resistance and Rifampicin Susceptibility

Clinical scenario

This protocol addresses pulmonary tuberculosis in patients where drug-susceptibility testing has confirmed isoniazid resistance while rifampicin susceptibility remains intact — a pattern requiring a distinct management strategy from standard drug-susceptible TB.

Resistance profile

Rifampicin-susceptible, isoniazid-resistant TB (Hr-TB) sits between fully drug-susceptible and multi-drug-resistant disease. Confirmed resistance testing is the basis for selecting this regimen. Treatment success is assessed by negative sputum smear at months 2, 5, and 6, with no emergence of resistance on culture.

Treatment approach

The recommended regimen for this scenario centres on a levofloxacin-containing combination. Where levofloxacin cannot be used, a defined alternative regimen applies.

Full regimen composition, duration, contingency options, and monitoring schedule are available in the structured protocol below.

Instant Access to Structured Evidence-Based Regimens

References

  1. In patients with confirmed rifampicin-susceptible, isoniazid-resistant tuberculosis, treatment with rifampicin, ethambutol, pyrazinamide and levofloxacin is recommended for a duration of 6 months.
  2. All medicines in this regimen are to be used daily for 6 months.
  3. If levofloxacin cannot be used because there is FQ resistance or intolerance or other contraindications to the use of FQ, then 6(H)RZE may be prescribed daily for 6 months.
  4. Bacteriological monitoring of sputum generally follows the same schedule as DS-TB, with direct microscopy at months 2, 5 and 6.
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