Objectives
  • Disseminate info on TB in India
  • Improve care of TB patients in India
  • Enable doctors and NGO's interested in TB control to interact

DRUG RESISTANCE IN TUBERCULOSIS:Treatment

The WHO has recommended some "acceptable regimens" for the management of multidrug resistant TB as follows:

Situation A:Susceptibility test results are not available before starting the new treatment:
Initial phase Continuation phase
Drugs Minimum duration
in months 		Drugs Duration in months
1 Aminoglycoside 3 Ethionamide 18
2 Ethionamide 3 Ofloxacin 18
3 Pyrazinamide 3
4 Ofloxacin 3
a)Kanamycin or amikacin or Capreomycin
b)The daily dose of 800mg can be reduced to 400mg if poorly tolerated.If ofloxacin is not available,use cycloserine

Situation B:Susceptibility test results are available before starting the new treatment:
Resistance to isoniazid alone or in combination with resistance ot streptomycin(and/or with thiacetazone)
Resistance to isoniazid and ethambutol with or without resistance ot streptomycin

Resistance to Initial phase Continuation phase
Drugs Minimum
Duration
in months 		Drugs Duration
in months
*Isoniazid
(Streptomycin
thiacetazone 		1.rifampicin
2.aminoglycoside
3.pyrazinamide
4.ethambutol 		2-3
2-3
2-3
2-3
 1.rifampicin
2.ethambutol 		6
6
*Isoniazid
and ethambutol
(streptomycin) 		1.rifampicin
2.aminoglycoside
3.pyrazinamide
4.ethionamide 		3
3
3
3
 1.rifampicin
2.ethionamide 		6
6
c)Streptomycin ,if still active;if resistance to streptomycin,use Kannamycin or Capreomycin
d)if ethionamide is not available or poorly tolerated(even at a dose of 500 mg /day)use ofloxacin

Acceptable third line regimens for the treatment of MDR TB

Situation B:a.Susceptibility test results are available before starting the new treatment:
Resistance to isoniazid and rifampiccin (with or without resistance to streptomycin)
b. Resistance to isoniazid ,rifampicin,ethambutol(with or without resistance ot streptomycin)

Resistance to Initial phase Continuation phase
Drugs Minimum
duration
in months 		Drugs Duration
in months
Isoniazid
rifampicin and
streptomycin 		1.aminoglycoside
2.ethionamide
3.pyrazinamide
4.ofloxacin
5.ethambutol 		3
3
3
3
3 		1.ethionamide
2.ofloxacin
3.cycloserine 		18
18
18
Isoniazid
rifampicin
streptomycin
and ethambutol 		1.aminoglycoside
2.ethionamide
3.pyrazinamide
4.ofloxacin
5.cycloserine 		3
3
3
3 		1.ethionamide
2.ofloxacin
3.cycloserine 		18
18
18
 e)Kanamycin or amikacin or Capreomycin
f)The daily dose of 800mg can be reduced to 400mg if poorly tolerated
b)PAS,if cycloserine is not available or too toxic

Introduction | Criteria of MDR TB | Causes | Prevention | Management | Dosage and side effects

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