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Appendix 2. Drugs for the treatment of tuberculosis

Drugs used in the chemotherapy of tuberculosis are divided into:

  1. first-line anti-tuberculosis drugs (basic, drugs for the treatment of tuberculosis caused by drug-susceptible mycobacteria): isoniazid, rifampicin, rifabutin, rifapentine, pyrazinamide, ethambutol, streptomycin;
  2. 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.
  3. 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

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