6.5 Tuberculosis and renal insufficiency

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The recommended initial TB treatment regimen for patients with renal failure or severe renal insufficiency is two months of isoniazid, rifampicin, pyrazinamide and ethambutol, followed by 4 months of isoniazid and rifampicin.

Isoniazid and rifampicin are eliminated by biliary excretion, so no change in dosing is necessary. Ethambutol and metabolites of pyrazinamide have significant renal excretion and thus, dosing adjustments are required. Three times per week administration of these two drugs at the following doses is recommended: pyrazinamide (25mg/kg), and ethambutol (15 mg/kg) specifically in late stages of renal disease (Stage 4 and Stage 5).

While receiving isoniazid, patients with severe renal insufficiency or failure should receive pyridoxine 10 mg daily in order to prevent peripheral neuropathy.