Drug-resistant tuberculosis
From IDWiki
- Mycobacterium tuberculosis infection that is resistant to both first-line drugs, isoniazid and rifampin
Classification
- Multidrug resistant tuberculosis (MDR-TB): resistance to isoniazid and rifampicin
- Extensively drug-resistant tuberculosis (XDR-TB): resistance to at least isoniazid and rifampicin, and to any fluoroquinolone, and to any of the three second-line injectables
- Totally drug-resistant tuberculosis (TDR-TB): not well-defined
Management
- 8 months of an intensive four-drug regimen that includes any four drugs to which it is susceptible, in order of preference:
- Any first-line agents to which it is still susceptible
- A fluoroquinolone (except ciprofloxacin)
- An injectable: kanamycin, or other parenteral agent
- Other second-line agents, starting with ethionamide
- Followed by 12 months of a less intensive regimen (at least three effective drugs), for a total of at least 20 months
| Resistance To | Drug to Stop | Drug to Add | Regimen | Total Duration |
|---|---|---|---|---|
| INH | INH | FQN | 6 months RMP+EMB+PZA+FQN | 6 months from date FQN started |
| INH | INH | FQN | 2 months RMP+EMB+PZA+FQN then 4 months RMP+EMB+FQN | 6 months from date FQN started |
| RMP | RMP | FQN | 2 months daily INH+EMB+PZA+FQN then 10-16 months INH+EMB+FQN | 18 months from date FQN started |
| RMP | RMP | None | 2 months INH+EMB+PZA, then 16 months INH+EMB | 18 months from date FQN started |
| EMB | EMB | None | 2 months INH+RMP+PZA, then 4 months INH+RMP | 6 months from start of therapy |
| PZA | PZA | None | 2 months INH+RMP+EMB, then 7 months INH+RMP | 9 months from start of therapy |
| INH+EMB | INH+EMB | FQN | 6 months daily RMP+PZA+FQN | 6 months from date FQN started |
| INH+PZA | INH+PZA | FQN | 9 months RMP+EMB+FQN | 9 months from date FQN started |
| INH+EMB+PZA | INH+EMB+PZA | FQN+injectable | 2 months TMP+FQN+injectable, then 7 months RMP+FQN | 9 months from date FQN started |
References
- ^ Bern-Thomas Nyang’wa, Catherine Berry, Emil Kazounis, Ilaria Motta, Nargiza Parpieva, Zinaida Tigay, Varvara Solodovnikova, Irina Liverko, Ronelle Moodliar, Matthew Dodd, Nosipho Ngubane, Mohammed Rassool, Timothy D. McHugh, Melvin Spigelman, David A.J. Moore, Koert Ritmeijer, Philipp du Cros, Katherine Fielding. A 24-Week, All-Oral Regimen for Rifampin-Resistant Tuberculosis. New England Journal of Medicine. 2022;387(25):2331-2343. doi:10.1056/nejmoa2117166.
