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Pulmonary Tuberculosis — RACP Adult Medicine MCQ

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EasyInfectious DiseasesPulmonary TuberculosisRACP Adult Medicine

A 55-year-old Aboriginal man from Central Australia presents with persistent cough, weight loss, and night sweats for 8 weeks. Chest X-ray shows bilateral upper lobe infiltrates with cavitation. Three sputum samples are positive for acid-fast bacilli on Ziehl-Neelsen stain. What is the standard initial treatment regimen for drug-susceptible pulmonary tuberculosis in Australia?

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Correct answer: C — Isoniazid + rifampicin + ethambutol + pyrazinamide for 2 months, then isoniazid + rifampicin for 4 months

Standard treatment for drug-susceptible TB in Australia is the WHO-recommended 6-month regimen: intensive phase of isoniazid (H) + rifampicin (R) + ethambutol (E) + pyrazinamide (Z) for 2 months, followed by continuation phase of HR for 4 months. Pyridoxine (vitamin B6) 25 mg daily should be co-prescribed with isoniazid to prevent peripheral neuropathy, especially in Aboriginal patients, malnourished patients, and those with HIV, diabetes, or alcoholism.

Reference: NTAC – 2022 – National TB Guidelines; eTG – 2025 – Antibiotic Guidelines