V. Treatment of Current (Active) Disease Therapy
Last Updated April 2026
The basic principles that underlie the treatment of pulmonary TB also apply to extrapulmonary forms of the disease. A 6-month course of therapy is recommended for treating tuberculosis involving any site with the exception of the meninges for which a 9 – to 12-month regimen is recommended. Prolongation of therapy also should be considered for patients with tuberculosis in any site that is slow to respond. The addition of corticosteroids is recommended for patients with TB meningitis as it is associated with a decrease in mortality as discussed below.
Lymphatic and hematogenous TB are especially common among persons with HIV infection. Central nervous system involvement has been reported and may be difficult to diagnose when it occurs in conjunction with other opportunistic CNS infections.
To establish the diagnosis of extrapulmonary TB, a variety of specimens including pleural fluid, peritoneal fluid, pleural and peritoneal biopsy specimens, lymph node tissue, bone marrow, bone, blood, urine, brain, or cerebrospinal fluid may need to be obtained for mycobacterial culture.
Specimens must be examined microscopically and sent for AFB culture, but the inability to demonstrate AFB on smear and the absence of granuloma formation does not exclude the diagnosis of TB. Surgery may be necessary to obtain specimens for diagnosis and to treat such processes as constrictive pericarditis or spinal cord compression from Pott’s disease. Evidence-based guidelines for the treatment of extrapulmonary TB and adjunctive use of corticosteroids are shown in Table 17.