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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.
|
NORMAL VALUE |
GRADE 1 (MILD) | GRADE 2 (MODERATE) | GRADE 3 (SEVERE) | GRADE 4 (LIFE THREATENING) |
|---|---|---|---|---|
|
QTcF |
Drugs used in Drug-resistant Tuberculosis (DR-TB) treatment may cause some common adverse effects in patients (as can be seen in figure below). It is important to know these relevant Adverse Drug Reactions (ADRs) to help in their swift identification and management.
Figure: Common or relevant adverse effects of drugs used in DR-TB treatment; Source: Guidelines on PMDT, India 2019, draft version, p115.
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Paradoxical Reaction
Occasionally, patients with HIV-related TB may experience a temporary exacerbation of symptoms, signs, or radiographic manifestation of TB after beginning TB treatment due to simultaneous administration of Anti-retroviral Treatment (ART) and TB medication. It was thought to be a result of immune reconstitution and is referred to as the Immune Reconstitution Inflammatory Syndrome (IRIS).
Symptoms and Signs
Pregnancy is not a contraindication for the treatment of Drug-resistant TB (DR-TB) but poses a great risk to both the mother and the foetus. All women of child-bearing age should be tested for pregnancy as part of the pre-treatment evaluation and whilst on treatment. Pregnant DR-TB patients need to be monitored carefully both in relation to the treatment and the progress of the pregnancy.
The table below provides the details about the clinical evaluation and laboratory tests that need to be done during Pre-treatment Evaluation (PTE) to initiate patients on shorter injectable-containing Multidrug-resistant (MDR)/ Rifampicin-resistant Tuberculosis (RR-TB) regimens.
PTE Objective
Drugs used for the treatment of drug-resistant TB have significant adverse effects. Hence, there is a need for PTE to rule out any underlying condition at the baseline, like co-morbid conditions, radiological abnormalities, Electrocardiogram (ECG) changes, or biochemical derangements.
PTE is essential to identify:
The following are the key counselling messages for patients with Tuberculosis (TB):
During the treatment of Drug-resistant TB (DR-TB) patients, there are some important points that patients and caregivers must be counselled on.
The table below shows all the aspects of DR-TB counselling that must be covered by health workers.
The inclusion and exclusion criteria for the use of Delamanid (Dlm) drug for Multidrug-resistance (DR)/ Rifampicin-resistance (RR) -TB patients are as follows:
The recommended dose of Bedaquiline (Bdq) for the treatment of Multidrug-resistant (DR)/ Rifampicin-resistant (RR) - TB in adults is: