One or two hepatotoxic drugs may be used in moderately severe disease (e.g., Childs B cirrhosis) whereas hepatotoxic drugs are completely avoided in decompensated Child C cirrhosis. •  Two hepatotoxic drugs
–  9 months of Isoniazid, Rifampin and Ethambutol (until or unless isoniazid susceptibility is
documented)
–  2 months of Isoniazid, Rifampin, Ethambutol and Streptomycin followed by 6 months of Isoniazid and Rifampin
•  One hepatotoxic drug
–  2 months of Isoniazid, Ethambutol & Streptomycin followed by 10 months of Isoniazid and Ethambutol
• No hepatotoxic drugs
– 18–24 months of Streptomycin, Ethambutol and Quinolones
Patients with liver disease should have their liver function tests monitored regularly throughout TB treatment. Drug-induced hepatitis is discussed in a separate section above. Pregnancy
Pregnancy itself is not a risk factor for TB. Rifampicin makes hormonal contraception less effective, so additional precautions need to be taken for birth control while tuberculosis treatment. Untreated TB in pregnancy is associated with an increased risk of miscarriage and major fetal abnormality, and treatment of pregnant women. The US guidelines recommend omitting PZA when treating TB in pregnancy; the UK and WHO guidelines make no such recommendation, and PZA is commonly used in pregnancy. There is extensive experience with the treatment of pregnant women with TB and no toxic effect of PZA in pregnancy has ever been found. High doses of RMP (much higher than used in humans) causes neural tube defects in animals, but no such effect has ever been found in humans. There may be an increased risk of hepatitis in pregnancy and during the puerperium.
DOTS is used with intermittent dosing (thrice weekly or 2HREZ/4HR3). Twice weekly dosing is effective but not recommended by the World Health Organization (WHO), because there is no margin for error (accidentally omitting one dose per week results in once weekly dosing, which is ineffective).Treatment with properly implemented DOTS has a success rate exceeding 95% and prevents the emergence of further multi-drug resistant strains of tuberculosis. Administering DOTS, decreases the possibilities of tuberculosis from recurring, resulting in a reduction in unsuccessful treatments. This is in part due to the fact that areas without the DOTS strategy generally provide lower standards of care. Areas with DOTS administration help lower the number of patients seeking help from other facilities where they are treated with unknown treatments resulting in unknown outcomes. However, if the DOTS program is not implemented or done so incorrectly positive results will be unlikely. For the program to work efficiently and accurately health providers must be fully engaged, links must be built between public and private practitioners, health services must be available to all, and global support is provided to countries trying to reach their TB prevention, and treatment aims. Some researchers suggest that, because the DOTS framework has been so successful in the treatment of tuberculosis in sub-Saharan Africa, DOTS should be expanded to non-communicable diseases such as diabetes mellitus, hypertension, and epilepsy. DOTS-Plus strategy
The WHO extended the DOTS programme in 1998 to include the treatment of MDR-TB (called "DOTS-Plus").