Author: Dr. Ahmed Farhan     Published: 2 years ago 1 Replies

How do you formulate treatment regimen for MDR TB?

MDR tuberculosis: When mycobacterium tuberculosis is resistant to both isoniazid and rifampicin

Treatment options: There are 3 regimes that can be individualized. Shorter (further divided into 2 regimes) and longer regimes. 

Shorter Regime:

  • 1st shorter regime: 9-12 month regime: A total of 7 drugs are used for the intensive phase for a period of 4-6 months: Initially these 7 drugs are given for 4 months, then sputum studies are done, in case of a positive result, continue these drugs for 2 more months (Total of 6 months). These 7 drugs are as follows
    1. Bidaqualine: For initial 6 months irrespective of Sputum studies
    2. Levofloxacin/moxifloxacin
    3. Clofazimine
    4. Ethionamide
    5. Ethambutol
    6. Isoniazid (high dose)
    7. Pyrazinamide

4 drugs are given for the period of 5 months: these drugs are

  1. Levofloxacin
  2. Clofizamine
  3. Pyrazinamide
  4. Ethambutol
  •  2nd shorter regime: 6-9 months:  BPal regime: It should be used when strict supervision can be done for adverse effects
    • Badequiline
    • Pretoaminid
    • Linezolid

Longer Regime: 18 months or more. Drugs are divided into 3 groups for the longer regime:

  1. Group A: Levofloxacin/ moxifloxacin, Bidaquiline or linezolid
  2. Group B: Clofazimine, Cycloserine or terizinidone
  3. Group C: Ethambutol, Delamanid, pyrazinamide, imipenem-cilastatin or meropenem, Amikacin or streptomycin, Ethionamide, P-aminosalicylic acid

How to give a longer regime: 

  1. For the initial 6 months: ​​​​​​​ Total 4 drugs: All 3 group A drugs plus 1of the group B drug
  2. For the next 12 months:  Except bedaquiline, continue the rest of 3 drugs which were being given the initial 6 months
  3. When medicine from group A or Group B can not be used, then drug from group C can be added to complete the regime

Indications of the longer regime: 

  1. Pregnancy: regimes containing ethionamide/ aminoglycosides are contraindicated
  2. Resistance to flouroquinolones
  3. 2nd line drug has been used for more than 1 month and then discontinued
  4. Extensive Tb: Bilateral cavitation or extensive parenchymal disease
  5. If age is less than 6 years
  6. Severe extrapulmonary tuberculosis:
    1. Tubercular meningitis
    2. Miliary tuberculosis
    3. If age is less than 15 years except lymph node TB
Muhammad Aadil Farooq, 2 years ago

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