V. Treatment of Current (Active) Disease Therapy

Last Updated April 2026

  1. The provider (or public health program) is responsible for prescribing an appropriate regimen and ensuring that treatment is completed successfully. Proven or suspected active TB must be reported to the local health department at the time treatment is initiated. The health department can assist with (or assume responsibility for if the clinician prefers) managing the TB treatment. The TB program can also provide access to TB experts throughout the state. Contact information for TB coordinators in each county is found in the Appendix and at the Georgia DPH website
  2. The decision to initiate treatment for active TB is often (appropriately) made prior to the confirmation of the diagnosis. Numerous factors are considered in making this decision and are outlined in Figure 1.
  3. Early or immediate reporting to the county health department or state TB program is indicated for:
  4. Directly Observed Therapy (DOT) to ensure adherence and treatment completion is the standard of care for all patients with active TB. DOT is managed by the county public health department. A variety of approaches to DOT, including Video DOT (vDOT), are employed by our TB program. The Georgia DPH TB Program provides patient-centered care for all patients. Treatment is tailored and supervised based on each patient’s clinical and social circumstances. TB treatment is most successful within a comprehensive framework that addresses both clinical and social issues of relevance to the patient.
  5. Drug susceptibility testing should be performed on initial M. tuberculosis isolates in ALL cases. Drug susceptibility testing and AFB cultures are performed by the Georgia Public Health Laboratory (Phone: 404-327-7945 or 404-327-7946).
  6. The best way to measure the effectiveness of therapy for pulmonary TB is to monitor patients bacteriologically through sputum examination at least monthly until two consecutive negative cultures are obtained. We recommend obtaining monthly sputum examinations throughout the course of therapy. For patients with pulmonary TB, it is essential to obtain a culture at the time when 2 months of therapy have been completed “the 2-month culture.”
  7. Patients being treated for uncomplicated pulmonary TB do not require frequent chest x-rays; bacteriologic examination is far more important than monitoring chest radiographs.
  8. If a patient’s sputum cultures remain positive for M. tuberculosis beyond 2 months of therapy, the possibility of drug-resistant disease, malabsorption, or patient non-adherence to taking medications as prescribed should be considered. Drug susceptibility testing studies should be repeated, and care should be reviewed with experts.
  9. Adjust weight-based doses as weight changes.