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Treatment for special contexts:

1.If no sputum tests are available

2.If well-organized follow-up will be difficult

3.If close to death and/or severe cachexia

4.If patient is untrustworthy/untruthful (non-compliance)

5.If present treatments are not working & it is not possible to refer


Drugs available:

Drug /patient weight



30-39 kg

40-49 kg

>50 kg

H= Isoniazid (INH)



300 mg

300 mg

300 mg

R= Rifampicin (RIF)



300 mg

450 mg

600 mg

Z= Pirazinamide (PZA)



1000 mg

1500 mg

2000 mg

E= Ethambutol (EMB)



600-800 mg


1200-1500 mg

S= Sreptomycin



500 mg

750 mg

1000 mg


1: If not able to check sputum and/or poor ward organization (not able to check if patients receive & take all drugs...which is common!)

Treatment category


For patients who:


2months HRZE

4months HR

- Suspected of having TB ("TB treatment test")

- TB test (+) but never received treatment


2months HRZES +1month HRZE

5months HRE

-  Relapse

- Not better after 2 months of Cat1

If patient stopped taking drugs on his/her own (first time):

Began treatment

Stopped taking the drugs

How to treat

<1 month ago

<2 weeks ago

Continue cat1

2-8 weeks ago

Start cat1 again

>8 weeks ago

Start cat1 again

1-2 months ago

<2 weeks ago

Continue cat1

2-8 weeks ago


>8 weeks ago

Start cat2

>2 months ago

<2 weeks ago

Continue cat1

2-8 weeks ago

Start cat2

> 8 weeks ago

Start cat2


2: If patient is not reliable or truthful (non-compliant)

If a patient stops taking drugs by him/herself twice for more than 3 days without a strong excuse... stop treatment.  A hospice must not be a place to select and promote resistant germs.


3: If present treatments are not working and it is not possible to refer

If no better, consider it is MAC and accept an inability to treat…


4: If the patient's condition is "too serious" to take drugs

- Consider ceasing treatment because TB drugs can sometimes make patients' lives very uncomfortable or even cause more suffering than the TB infection itself.  (Sometimes stopping TB drugs may give a patient a few extra months of comfortable living)

- Consider ceasing treatment in situations where the digestive tract of a cachectic patient does not fully absorb drugs -- which can be a cause of drug resistance

...It is better to stop TB drugs for patients who are close to death or in very bad condition ('tired intestine") (xxx001) (xxx005) (xxx008) (xxx009).



Symptomatic care:

(see "12-Dyspnea/Polypnea", "23-Pain", "18-Last Step", "9-Dexa"...)



    • O2, dexamethasone

COUGHING AND SPUTUM (danger for other patients!)

    • "Dry" secretions with Buscopan 1-2tabs 3-4x/day
    • Strong anti-tussive drugs: codeine syrup1-2 doses 3-4x/day


    • Ventolin 1-2 tabs 3x/day, +/- theophylline200mg 1-2tabs 3x/day, +/- dexa









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paul yves wery - aidspreventionpro@gmail.com

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