First-Line Treatment Regimen (6 months):

• Initial Phase (2 months): Rifampicin, Isoniazid, Pyrazinamide, Ethambutol (RIPE)
  • Rationale: Combination therapy targets different bacterial populations to prevent resistance.
• Continuation Phase (4 months): Rifampicin, Isoniazid
  • Rationale: Maintains suppression of persisting organisms.

• Drug-Resistant TB (MDR/RR-TB):
  • MDR-TB: Resistant to Rifampicin + Isoniazid; requires 20-month regimen with fluoroquinolones, injectables (e.g., Kanamycin), and second-line drugs (e.g., Ethionamide).
  • RR-TB: Resistant to Rifampicin only; treated similarly to MDR-TB.

• Key Principles:
  • Directly Observed Therapy (DOT): Ensures adherence to prevent resistance.
  • Dormant TB: Latent TB requires Isoniazid for 6–9 months or Rifampicin for 4 months.

• Monitoring:
  • Sputum culture conversion: Assesses treatment response.
  • Adverse effects: Monitor for hepatotoxicity (e.g., Rifampicin, Isoniazid), ototoxicity (injectables), and peripheral neuropathy (Isoniazid).

• Surgical Considerations:
  • Indicated for complications (e.g., spinal TB with instability) or drug-resistant cases.
  • Post-surgical recovery often allows return to work (e.g., 57% in historical data).

• Diagnosis:
  • Molecular tests (e.g., GeneXpert MTB/RIF): Rapid detection of TB and Rifampicin resistance.
  • Culture: Gold standard for drug susceptibility testing.

• Public Health Role:
  • Isolation for infectious cases until non-infectious (e.g., negative sputum cultures).

Rationale: Slow replication and natural resistance require prolonged, multi-drug regimens to eradicate all bacterial populations.