Treatment of tuberculosis in special cases

Certain patient groups require special considerations during the treatment and prevention of tuberculosis (TB). These include patients co-infected with HIV, pregnant or breastfeeding women, individuals eligible for TB preventive therapy (TPT), and patients with liver or kidney disease.

Treatment of TB/HIV co-infected patients

Patients with TB and HIV require coordinated management of both conditions.

Antiretroviral therapy (ART) recommendations

Clinical situation	Recommendation
Newly diagnosed TB patient living with HIV	Start anti-tuberculosis treatment first, then initiate antiretroviral therapy (ART) as soon as possible, preferably within two weeks of starting TB treatment, regardless of CD4 count.
Patient already receiving ART at the time of TB diagnosis	Continue management according to the HIV and AIDS treatment guidelines.

Treatment of tuberculosis in Pregnancy and breastfeeding

Anti-tuberculosis medicines are considered safe during pregnancy and breastfeeding.

TB preventive therapy (TPT) is not contraindicated during pregnancy and may be administered during any trimester.

For mothers with pulmonary tuberculosis who are breastfeeding, the infant should receive isoniazid preventive therapy at 5 mg/kg once daily for six months, followed by Bacillus Calmette-Guérin (BCG) vaccination.

Tuberculosis preventive therapy

TB preventive therapy (TPT) is recommended for:

Household contacts under five years of age who are exposed to bacteriologically confirmed pulmonary tuberculosis and have no evidence of active TB.
All people living with HIV (PLHIV) who do not have active tuberculosis.

Dosage

Adults and adolescents

Isoniazid 300 mg orally once daily for 6 months to complete one cycle of TPT.

Children

Isoniazid 10 mg/kg orally once daily (acceptable range: 10–15 mg/kg) for 6 months.

Important notes

TB preventive therapy should be given only once in a lifetime, and repeat treatment is generally not required.
People living with HIV who successfully complete tuberculosis treatment should immediately receive six months of TB preventive therapy.
Pyridoxine should be administered if isoniazid-induced peripheral neuropathy develops.
TB preventive therapy is safe during pregnancy and may be started during any trimester.

Oral contraceptives

Rifampicin reduces the effectiveness of oral contraceptives through drug interactions. Women using oral contraceptives while taking rifampicin should be advised to use an alternative or additional non-hormonal contraceptive method.

Treatment of tuberculosis in Liver disease

Most anti-tuberculosis medicines have the potential to cause hepatotoxicity.

If a patient develops jaundice during treatment:

Stop anti-tuberculosis treatment immediately.
Restart treatment once the jaundice has resolved.
In severely ill patients, initiate treatment with moxifloxacin and ethambutol while awaiting recovery of liver function.

Treatment of tuberculosis in Renal failure

Ethambutol is primarily excreted by the kidneys.

In patients with renal impairment:

Avoid ethambutol when possible, or
Administer a reduced dose according to the degree of renal dysfunction.

Imeandikwa:

Ijumaa, 26 Juni 2026, 10:35:54 GMT +3

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