Tb tsblet combination
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TB tablet fixed dose combination FDC WHO regimen HRZE 2024
Here is a clear breakdown of TB fixed-dose combination (FDC) tablets:
TB Fixed-Dose Combination (FDC) Tablets
What is an FDC?
An FDC tablet contains two or more anti-TB drugs in fixed doses in a single pill. They simplify dosing, improve adherence, and prevent selective drug-taking (which causes resistance).
Standard Drug-Sensitive TB (DS-TB) Regimen
The standard regimen is 2HRZE / 4HR(E) - 2 months intensive phase + 4 months continuation phase.
Drugs & Abbreviations
| Abbreviation | Drug | Standard Adult Daily Dose |
|---|---|---|
| H | Isoniazid | 5 mg/kg (max 300 mg) |
| R | Rifampicin | 10 mg/kg (max 600 mg) |
| Z | Pyrazinamide | 25 mg/kg |
| E | Ethambutol | 15 mg/kg |
Adult FDC Tablets (NTEP/WHO)
Intensive Phase (IP) - 2 months: 4-FDC (HRZE)
Each tablet contains:
- Isoniazid 75 mg + Rifampicin 150 mg + Pyrazinamide 400 mg + Ethambutol 275 mg
Continuation Phase (CP) - 4 months: 3-FDC (HRE)
Each tablet contains:
- Isoniazid 75 mg + Rifampicin 150 mg + Ethambutol 275 mg
Weight-Based Dosing (Adults)
| Body Weight | IP Tablets (HRZE) | CP Tablets (HRE) |
|---|---|---|
| 25-34 kg | 2 tablets | 2 tablets |
| 35-49 kg | 3 tablets | 3 tablets |
| 50-64 kg | 4 tablets | 4 tablets |
| 65-75 kg | 5 tablets | 5 tablets |
| >75 kg | 6 tablets | 6 tablets |
Paediatric FDC Tablets (Dispersible)
Child-friendly flavoured dispersible FDCs:
- RHZ - Rifampicin 75 mg + Isoniazid 50 mg + Pyrazinamide 150 mg (IP)
- RH - Rifampicin 75 mg + Isoniazid 50 mg (CP)
- Ethambutol 100 mg - separate dispersible tablet (added in IP)
Paediatric Weight-Band Dosing
| Weight (kg) | IP: RHZ + E | CP: RH |
|---|---|---|
| 4-7 kg | 1 tab | 1 tab |
| 8-11 kg | 2 tabs | 2 tabs |
| 12-15 kg | 3 tabs | 3 tabs |
| 16-24 kg | 4 tabs | 4 tabs |
| ≥25 kg | Switch to adult FDC |
Key Points
- Pyridoxine (Vitamin B6) 10 mg/day is given alongside to prevent isoniazid-induced peripheral neuropathy
- If weight increases by >5 kg during treatment, dose should be reassessed
- For TB meningitis: regimen is extended - 2HRZE + 10HRE, plus prednisolone 2 mg/kg/day for 4 weeks
- For osteoarticular TB: 2HRZE + 10HRE
- FDCs are NOT used in rifampicin-resistant (RR-TB) or MDR-TB - those require individualized regimens with newer drugs (bedaquiline, linezolid, pretomanid, etc.)
Renal Dose Adjustment (FDC)
When eGFR <30 mL/min:
- Rifampicin + Isoniazid (RH component): no change needed
- Pyrazinamide and Ethambutol: dose adjustment required (reduce frequency or dose - avoid standard HRZE FDC; use individual drugs)
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