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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:

Delamanid (Dlm) is considered only for the longer oral Multi (M)/ Extensively Drug-resistant TB (XDR-TB) regimen as per the Programmatic Management of Drug-resistant TB (PMDT) guidelines.

• Formulation: Film-coated tablet with 50 mg Delamanid

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• Duration:  24 weeks

         The Optimal Background Regimen (OBR) will be continued beyond the 24 weeks of Dlm administration.

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Adverse Drug Reactions (ADRs), such as renal toxicity, may occur from the Drug-resistant TB (DR-TB) treatment regimen.

Suspected agent(s): Amikacin (Am)

Adverse Drug Reactions (ADRs), such as seizures, may occur from the Drug-resistant TB (DR-TB) treatment regimen.

Suspected agent(s): Cycloserine (Cs), Isoniazid (H), Fluoroquinolone (FQ)

Suggested Management Strategies

Adverse Drug Reaction (ADR), such as suicidal ideation, may occur from the Drug-resistant TB (DR-TB) treatment regimen.

​​Suspected agent(s): Cycloserine (Cs), Isoniazid (H), Ethionamide (Eto)

Suggested Management Strategies

• Hospitalize the patient and put them under 24-hour surveillance.
• Discontinue Cs.
• Request psychiatric consultation. 
• Initiate antidepressant treatment.
• Lower the dose of Eto until the patient is stable.

Adverse Drug Reactions (ADRs), such as psychotic symptoms, may occur from the Drug-resistant TB (DR-TB) treatment regimen.

Suspected agent(s): Cycloserine (Cs), Isoniazid (H), Fluoroquinolone (FQ)

Suggested Management Strategies

Adverse Drug Reaction (ADR), such as depression, may occur from the Drug-resistant TB (DR-TB) treatment regimen.

Suspected agent(s): Cycloserine (Cs), Fluoroquinolone (FQ), Isoniazid (H), Ethionamide (Eto)

Psychological and socioeconomic circumstances, chronic disease are also important factors of depression.

Suggested Management Strategies

Adverse Drug Reactions (ADRs), such as arthralgia, may occur from the Drug-resistant TB (DR-TB) treatment regimen.

Suspected agent(s): Pyrazinamide (Z), Fluoroquinolone (FQ), Bedaquiline (Bdq)

Suggested Management Strategies​

Adverse Drug Reactions (ADRs), such as hypothyroidism, may occur from the Drug-resistant TB (DR-TB) treatment regimen.

Figure: Symptoms of Hypothyroidism

Suspected agent(s): Ethionamide (Eto), Para Aminosalicylic Acid (PAS)   Suggested Management Strategies: