Drug-resistant tuberculosis medical therapy

Tuberculosis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Tuberculosis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Children
HIV Coinfection
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
CT
MRI
Echocardiography or Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Special Conditions
Drug-resistant
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Drug-resistant tuberculosis medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Drug-resistant tuberculosis medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Drug-resistant tuberculosis medical therapy
CDC on Drug-resistant tuberculosis medical therapy
Drug-resistant tuberculosis medical therapy in the news
Blogs on Drug-resistant tuberculosis medical therapy
Directions to Hospitals Treating Tuberculosis
Risk calculators and risk factors for Drug-resistant tuberculosis medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]

Multiple Drug-Resistant (MDR) Tuberculosis Adapted from WHO 2013 Treatment of tuberculosis: guidelines – 4th ed.

• MDR-TB is defined as resistance to isoniazid and rifampicin, with or without resistance to other first-line drugs.
• Medical treatment for MDR-TB consists of at least 4 drugs that have shown effectiveness against MDR. Within these 4 drugs must be included at least one drug from each group.
• Treatment duration will depend on the culture results. The duration of therapy should be > 18 months after culture is negative.
• Chronic cases with severe pulmonary disease may require more than 24 months of therapy.

MDR Tuberculosis   ▸  Adults   ▸  Children

MDR-TB Adults Standard Regimen Group 1: First-line oral drugs ▸ Pyrazinamide 20–30 mg/kg OR ▸ Ethambutol 15–25 mg/kg OR ▸ Rifabutin 5 mg/kg PLUS Group 2: Injectable drugs ▸ Kanamycin 15 mg/kg OR ▸ Amikacin 7.5-10 mg/kg OR ▸ Capreomycin 15 mg/kg OR ▸ Streptomycin 12–18 mg/kg PLUS Group 3: Fluoroquinolones ▸ Levofloxacin 500-1000 mg OR ▸ Moxifloxacin 400 mg OR ▸ Ofloxacin 400 mg PLUS Group 4:Oral bacteriostatic second-line drugs ▸ Para-aminosalicylic acid 8-12 g/d divided q8-12h OR ▸ Cycloserine 10-15 mg/kg OR ▸ Terizidone OR ▸ Ethionamide 15-20 mg/kg OR ▸ Protionamide Table adapted from WHO 2013 Treatment of tuberculosis: guidelines – 4th ed. MDR-TB Children Standard Regimen Group 1: First-line oral drugs ▸ Pyrazinamide OR ▸ Ethambutol OR ▸ Rifabutin PLUS Group 2: Injectable drugs ▸ Kanamycin OR ▸ Amikacin OR ▸ Capreomycin OR ▸ Streptomycin PLUS Group 3: Fluoroquinolones ▸ Levofloxacin OR ▸ Moxifloxacin OR ▸ Ofloxacin PLUS Group 4:Oral bacteriostatic second-line drugs ▸ Para-aminosalicylic acid OR ▸ Cycloserine OR ▸ Terizidone OR ▸ Ethionamide OR ▸ Protionamide Table adapted from WHO 2013 Treatment of tuberculosis: guidelines – 4th ed.

Extensively Drug-Resistant XDR Tuberculosis

• XDR-TB is defined as resistance to at least isoniazid and rifampicin, and to any fluoroquinolone, and to any of the three second-line injectables (amikacin, capreomycin, and kanamycin).
• Additional drugs are needed for XDR treatment regimen, these drugs are known to have some action against tuberculosis but are not routinely recommended for treatment of MDR-TB.
• These include clofazimine, linezolid, amoxicillin/clavulanate, thioacetazone, imipenem/cilastatin, clarithromycin and high-dose isoniazid.

XDR Tuberculosis   ▸  Adults   ▸  Children

XDR-TB Adults Preferred Regimen ▸ ' XDR-TB Children Preferred Regimen ▸