Published on LMS

The total duration of a longer oral Multidrug/ Extensively drug-resistant TB (M/XDR-TB) regimen is 18–20 months. ​

There is a high baseline incidence of depression and anxiety in patients with Multidrug-resistant (MDR)/ Extensively Drug-resistant TB (XDR-TB) patients. Special precautions need to be taken for M/XDR-TB treatment-initiated patients suffering from pre-existing psychiatric illnesses.

Drugs Associated with Psychosis: Cycloserine (Cs), High-dose Isoniazid (H^h), Fluoroquinolone (FQ) and Ethionamide (Eto) 

The treating physician should elicit the history of past or present seizure disorders in all Drug-resistant TB (DR-TB) patients.​

If the seizures are not under control, initiation or adjustment of anti-seizure medications will be needed before the start of DR-TB treatment. ​In addition, if other underlying conditions or causes for seizures exist, they should be corrected.​

In Drug-resistant TB (DR-TB) patients with localized disease, surgery, as an adjunct to chemotherapy, can improve outcomes; provided that skilled thoracic surgeons and excellent postoperative care is available.​

A patient with a unilateral resectable disease may be considered for surgery if there is: ​

All women of childbearing age who are awaiting results of the Culture and Drug Susceptibility Test (C&DST), as well as those receiving Drug-resistant TB (DR-TB) treatment, should be advised and counselled intensively to use birth control measures because of the potential risk to both the mother and the foetus.​

The principles for the treatment and monitoring of Multidrug-resistant (MDR)/ Rifampicin-resistant TB (RR-TB) in children are quite similar to adults and use the same second-line drugs. 

Principles 

Apart from clinical evaluation, the patients need to be closely assessed by various laboratory parameters to monitor the improvement on treatment, drug-induced adverse events or co-morbidities to enable timely interventions to address these and improve the probability of treatment success, survival and quality of life.

The following points should be covered in follow-up monitoring of Drug-resistant TB (DR-TB) patients:

Because of the risk for potential drug-drug interactions, the following medications are not allowed during the 24-week administration of Bedaquiline (Bdq) and up to one month after the last dose of Bdq:

Drug dose administration for shorter/ longer oral Bedaquiline (Bdq)-containing Multidrug-resistant (MDR)/ Rifampicin-resistant (RR)-TB regimen depends on the factors described below.