Drugs used in the chemotherapy of tuberculosis are divided into:
- first-line anti-tuberculosis drugs (basic, drugs for the treatment of tuberculosis caused by drug-susceptible mycobacteria): isoniazid, rifampicin, rifabutin, rifapentine, pyrazinamide, ethambutol, streptomycin;
- second-line anti-TB drugs (reserve drugs for the treatment of tuberculosis with MDR MBT): bedaquiline, linezolid, levofloxacin, moxifloxacin, sparfloxacin, kanamycin, amikacin, capreomycin [imipenem + (cilastatin)], meropenem, cycloserine, terizidone, prothionamide, ethionamide, aminosalicylic acid, thioureidoiminomethylpyridinium perchlorate.
- other anti-tuberculosis and antibacterial drugs, which are used to treat tuberculosis with a broadly drug-resistant pathogen — clarithromycin, clofazimine.
Some of the anti-tuberculosis drugs, due to the peculiarities of the spectrum of activity, are also used for other infections caused by mycobacteria (leprosy, etc.).
WHO recommends the division of drugs into 3 groups depending on the ratio of their benefits and harms:
- group A: the fluoroquinolones (levofloxacin and moxifloxacin), bedaquiline, and linezolid are considered highly effective and are strongly recommended for inclusion in all regimens unless contraindicated;
- group B: cycloserine or terizidone and some other drugs not registered in the Russian Federation are conditionally recommended as second-choice drugs;
- group C: this includes all other drugs that can be used if the regimen cannot be composed of drugs from groups A and B. Drugs in group C are sorted according to the standard expected relative balance of benefits and harms for each. It is strongly recommended to start chemotherapy for tuberculosis as soon as possible after the establishment and verification of the diagnosis in order to improve the results of treatment.
Daily doses for adults
A drug | Daily doses for adults (when taking drugs daily) |
day | max., mg |
Isoniazid | 4–6 mg/kg | 600 |
Rifampicin | 10 mg/kg | 600 |
Pyrazinamide | 20–30 mg/kg | 2500 |
Ethambutol | 15–25 mg/kg | 2000 |
Streptomycin | 15 mg/kg | 2000 |
Kanamycin | 15–20 mg/kg | 1000 |
Amikacin | 15–20 mg/kg | 1000 |
Levofloxacin | 10–15 mg/kg | 750–1000 |
Moxifloxacin | 400–800 mg | 800 |
Sparfloxacin | 200–400 mg | 400 |
Prothionamide, ethionamide | 15–20 mg/kg | 1000 |
Capreomycin | 15–20 mg/kg | 1000 |
Cycloserine | 10–15 mg/kg | 1000 |
Terizidone | 10–15 mg/kg | 750–1000 |
Pair of aminosalicylic acid (PAS) | 8–12 g/day in 2–3 doses | 8000–12 000 |
Bedaquiline | 400 mg daily for the first 2 weeks, followed by 200 mg three times a week with a 3-week break between drug intake, ensuring at least 48 hours between doses |
Linezolid | 600 mg | 1200 |
Imipenem + cilastatin | 2000 mg + 2000 mg | 2000+2000 |
Meropenem | 3000–4000 mg | 4000 |
Thioureidoiminomethylpyridinium perchlorate | 9.5–12.5 mg/kg | 1200 |
Clofazimine | | 300 |
Clarithromycin | 250 mg 2 times a day | 500 |
Amoxicillin + clavulanic acid | 500 mg 2 times a day | 1000 |
Rifabutin | 150–450 mg | 450 |
Rafapentin | 10 mg/kg of body mass 2–3 times in week |