Drug-resistant tuberculosis

• Mycobacterium tuberculosis infection that is resistant to both first-line drugs, isoniazid and rifampin

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