Treating drug-resistant tuberculosis (TB) is complicated, and CDC advises that it be managed by or in close consultation with an expert. State and local TB programs and CDC’s TB Centers of Excellence for Training, Education, and Medical Consultation can help.
The ground rules
- Review the patient’s other conditions, current medicines and drug susceptibility test results before choosing drugs.
- Use only drugs the patient’s Mycobacterium tuberculosis strain is known — or highly likely — to be susceptible to. Treating with drugs the strain resists can lead to poor outcomes and to resistance to still more drugs.
- A temporary regimen based on clinical and epidemiologic information may be used while susceptibility results are pending.
- The regimen also depends on drug interactions, other conditions, patient preferences, the drugs’ harms and benefits, the ability to monitor for side effects, and drug availability.
- Treatment length depends on the clinical situation, how extensive the disease is and how the patient responds. Directly observed therapy is recommended to make sure treatment is completed and side effects are caught.
Isoniazid-resistant TB
TB resistant to isoniazid only (isoniazid monoresistance) is treated with a 6-month daily regimen of:
- rifampin
- ethambutol
- pyrazinamide
- a later-generation fluoroquinolone
In some situations, pyrazinamide can be stopped after two months.
Rifampin-resistant and multidrug-resistant TB
Multidrug-resistant TB (MDR TB) is caused by bacteria resistant to at least isoniazid and rifampin. For people 14 and older with rifampin-resistant pulmonary TB, two six-month regimens are available:
| Regimen | Drugs | For |
|---|---|---|
| BPaLM | bedaquiline, pretomanid, linezolid, moxifloxacin | TB that is still susceptible to fluoroquinolones |
| BPaL | bedaquiline, pretomanid, linezolid | TB resistant to, or patients intolerant of, fluoroquinolones |
Both are for people with no earlier exposure to bedaquiline and linezolid, or exposure of less than 1 month, and are also options for people who cannot tolerate rifampin. Patients should be monitored for two years after finishing treatment.
People who cannot take BPaL — because of resistance or intolerance to bedaquiline, pretomanid or linezolid, severe TB outside the lungs, pregnancy, breastfeeding, or being under 14 — can receive an individualized regimen based on the 2019 ATS/CDC/ERS/IDSA guideline on drug-resistant TB.
Treating contacts
For people with latent TB infection exposed to someone with drug-resistant TB:
| Source patient’s TB | Contact’s treatment may be |
|---|---|
| Isoniazid-resistant, rifampin-susceptible | 4 months of daily rifampin |
| Rifampin-resistant, isoniazid-susceptible | 6 or 9 months of isoniazid |
| MDR TB | 6–12 months of a later-generation fluoroquinolone, alone or with a second drug, guided by the source case’s susceptibility results |
For MDR latent infection, clinicians should consult an MDR TB expert on the best options.
Sources
Based on "Treatment for Drug-Resistant Tuberculosis Disease," Centers for Disease Control and Prevention, which refers to the ATS/CDC/ERS/IDSA clinical practice guidelines; a work of the United States government in the public domain. The source’s misspellings “isonaizid” and “fluroquinolone” are corrected.
Licence: CC0 1.0 (public domain) · Adapted from www.cdc.gov
1
0
0
0
Comments
