The total duration of treatment in this regimen is 9-11 months with Intensive Phase (IP) at least 4 months and Continuation Phase (CP) for 5 months. Treatment extension of IP is done up to 2 months based on follow-up results and is indicated in the algorithm presented in the figure below.
Figure: Treatment Extension/ Regimen Change Based on Follow up Smear/ Culture/ DST Results
Based on the World Health Organization (WHO) treatment guidelines, 2020 recommendations, the National TB Elimination Programme (NTEP) have decided to transition from the current shorter injectable-containing Multi-drug Resistant (MDR)/ Rifampicin-resistant TB (RR-TB) regimen to the shorter oral bedaquiline-containing MDR/RR-TB regimen in the year 2021.
Salient Features of the Shorter Oral Bedaquiline-containing MDR/RR-TB Regimen
Pre-treatment counselling must serve as an informed decision-making process that enables patients to make a duly informed decision regarding the use of all anti-TB drugs and regimen, including newer drugs.
Written consent is not needed for any treatment regimen under National TB Elimination Programme (NTEP).
 Figure: Key points to be covered during pre-treatment counselling; Source: PMDT Guidelines India, 2021, p45.
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Drug resistance is caused by a genetic mutation that makes the drug ineffective against the mutant bacilli.
The causes of drug-resistant TB can be enumerated as follows:
1. Providers/ Programme Related Causes:
2. TB Patient/ Host Related Causes:
There are two main evaluations that must be conducted during pre-treatment evaluation to initiate patients on a shorter oral bedaquiline-containing MDR/RR-TB regimen. These evaluations are:
Clinical Evaluation
Laboratory-based Evaluation
 Figure: Sirturo 100 mg Bedaquiline Tablets
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The dosage for Drug-resistant TB (DR-TB) drugs used in the regimen by weight bands for adults are enumerated in the table below.
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SR NO |
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It is a well-known fact that although free, quality diagnostic, treatment and patient support services are available in the public health sector, a significant number of patients seek health services from the large, unorganized private health sector.
Reaching out to these patients is important to:
In view of the availability of expertise in medical colleges, there is a felt need to leverage their strength to improve clinical, Adverse Drug Reactions (ADRs) and comorbidity management of patients with Drug-resistant Tuberculosis (DR-TB) across India.
The following functions and package of services should be offered at each District Drug-resistant Tuberculosis Centre (DDR-TBC):
Figure: Functions of DDR-TBCs
Abbr: NDR-TBC: National Drug-resistant TB Centre; AIC: Airborne Infection Control
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