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 |
