A 41-year-old man presents to the emergency department with a 6-week history of productive cough, intermittent hemoptysis, night sweats, fevers, and a 5 kg weight loss. He immigrated to Canada 2 years ago from a country with a high incidence of tuberculosis and has never been treated for tuberculosis. He takes no medications, has no allergies, and weighs 60 kg. Chest x-ray shows a right upper-lobe cavitary infiltrate. Sputum smear is positive for acid-fast bacilli, and a nucleic acid amplification test identifies Mycobacterium tuberculosis with no rifampin resistance. HIV serology is negative. ALT is 28 U/L (7-40), AST is 30 U/L (10-40), bilirubin is 10 µmol/L (less than 21), and creatinine is 78 µmol/L (60-110). He is placed in a negative-pressure room and public health is notified.
| Heart rate | 96/min |
| Respiratory rate | 18/min |
| Temperature | 37.9 °C |
| O2 saturation | 96%, room air |
| Blood pressure | 118/72 mm Hg |
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Which one of the following is the most appropriate initial drug regimen?
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