Drug-resistant tuberculosis

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Revision as of 13:58, 18 November 2022 by Aidan (talk | contribs) ()

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