The management of hepatotoxicity during treatment with H mono/poly Drug-resistant TB (DR-TB) regimen is elaborated in the figure below.

Figure: Management of hepatotoxicity during treatment with H mono/poly DR-TB regimen; Source: Guidelines for PMDT, India 2021, p89.

Abbr: AST: Aspartate aminotransferase; ALT: Alanine transaminase; FQ: Fluoroquinolone; R: Rifampin; Z: Pyrazinamide; UNL: Upper Normal Level

The state Airborne Infection Control (AIC) committee meetings should be organized on a quarterly basis with the following functions: 

The state Programmatic Management of Drug-resistant Tuberculosis (PMDT) committee is expected to meet quarterly on the Terms of Reference (ToRs) provided in the figure below.

Figure: Terms of Reference (ToRs) of the State PMDT Committee; Source: Guidelines for PMDT in India, 2021, p204.

Resources

Management of increased QTcF in Electrocardiogram (ECG) entails looking at the algorithm for the reintroduction of anti-TB drugs (Bedaquiline (Bdq)/ Delamanid (Dlm)/ Fluoroquinolone (FQ)/ Clofazimine (Cfz)) once prolonged QTc has normalized, as shown in the below figure.

Figure: Management of prolonged QTcF during treatment with shorter/ longer oral MDR-TB regimen; Source: Guidelines for PMDT, India 2021, p85.

Resources

Management of increased QT prolongation (QTcF) entails looking at the grade of severity of the Adverse Drug Reaction (ADR), details of which is provided in the table below.