Synopsis
Recognise infectious pulmonary tuberculosis, protect patients and contacts immediately, obtain microbiological confirmation and resistance information, and coordinate specialist multidrug treatment, toxicity monitoring and statutory public-health action.
- Think of pulmonary TB with cough lasting weeks, weight loss, fever, night sweats, haemoptysis or unexplained upper-lobe/cavitary change, especially after exposure or residence in a high-incidence setting.
- Older, immunocompromised and pregnant patients may have atypical or disseminated disease; ask about HIV risk, immunosuppressants, housing, detention, homelessness and prior TB treatment.
- Place potentially infectious pulmonary or laryngeal TB in the locally approved airborne-isolation pathway and involve infection prevention and the specialist TB service immediately.
Key red flags
Persistent cough, sputum or haemoptysis with weight loss, anorexia, fever and night sweats; radiology may show upper-lobe infiltrates, cavitation, nodules or lymphadenopathy.
Investigation priorities
Identify pulmonary patterns and guide respiratory sampling while assessing severity.
Management branches
Compatible pulmonary illness with epidemiological or radiological concern.
- Use local airborne precautions and appropriate room/respirator arrangements, minimise avoidable transfers and inform infection prevention and the TB team.
- Obtain respiratory samples for smear, culture and molecular testing, plus baseline bloods and HIV testing, without delaying treatment in a severely ill person.
Key medicines
Rifampicin, isoniazid, pyrazinamide and ethambutolGive once daily using the current specialist weight-banded BNF/NICE regimen for the usual 2-month intensive phase; fixed-dose combinations may be used when suitable.
Rifampicin plus isoniazid continuationUse the current daily weight-banded specialist regimen for a usual further 4 months after the intensive phase when susceptibility and disease site support six total months.