A 30-year-old man from rural India presents with hemoptysis, low-grade fever, night sweats, and weight loss for 3 months. Sputum AFB smear is positive (2+). He has no prior history of TB treatment. CXR shows right upper lobe cavitary infiltrate. Which regimen should be initiated?
- A Isoniazid, rifampicin, pyrazinamide, ethambutol for 2 months, then isoniazid and rifampicin for 4 months (2HRZE/4HR) ✓
- B Isoniazid and rifampicin for 6 months (2HR/4HR)
- C Streptomycin, isoniazid, rifampicin for 9 months
- D Rifampicin and pyrazinamide for 2 months only
Correct answer: A. Isoniazid, rifampicin, pyrazinamide, ethambutol for 2 months, then isoniazid and rifampicin for 4 months (2HRZE/4HR)
Explanation
The standard WHO-recommended first-line regimen for new pulmonary tuberculosis is a 6-month regimen: 2 months of HRZE (isoniazid, rifampicin, pyrazinamide, ethambutol) as the intensive phase, followed by 4 months of HR (isoniazid, rifampicin) as the continuation phase. This regimen achieves bacteriologic cure in over 95% of drug-susceptible cases. Directly observed therapy (DOT) is recommended to ensure adherence and prevent emergence of drug resistance.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.