Tuberculosis — SCE Infectious Diseases MCQ

Correct answer: E — Two months of isoniazid, rifampicin, pyrazinamide and ethambutol followed by 10 months of isoniazid and rifampicin, with adjunctive corticosteroid taper after susceptibility review with review

The best answer is “Two months of isoniazid, rifampicin, pyrazinamide and ethambutol followed by 10 months of isoniazid and rifampicin, with adjunctive corticosteroid taper after susceptibility review with review”. CNS tuberculosis requires a 12-month regimen and early dexamethasone or prednisolone tapered over several weeks. “Six months of standard pulmonary-TB therapy without corticosteroids” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Twelve months of isoniazid and rifampicin without an intensive phase” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Two months of four drugs followed by four months of two drugs” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Antimicrobials alone because corticosteroids increase mortality” is less appropriate because it conflicts with the decisive clinical feature or cited guidance.

Reference: NICE NG33 tuberculosis recommendations: https://www.nice.org.uk/guidance/ng33/chapter/Recommendations