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Renal insufficiency due to longstanding TB disease itself, previous use of aminoglycosides or concurrent renal disease is not uncommon and great care should be taken in the administration of second-line drugs in such patients.
Drugs that might require a dose or interval adjustment when there is mild to moderate renal impairment are Ethambutol (E) and Levofloxacin (Lfx). In cases with severe renal impairment, Lfx can be replaced with a normal dose of Moxifloxacin (Mfx) (200/400 mg/kg).
The table below shows the dosage requirements for drugs in the shorter oral Bedaquiline (Bdq)-containing Multidrug-resistant (MDR)/ Rifampicin-resistant TB (RR-TB) regimen.
|
DRUG |
RECOMMENDED DOSE AND FREQUENCY FOR PATIENTS WITH CREATININE CLEARANCE <30 ML/MIN OR FOR PATIENTS RECEIVING HAEMODIALYSIS (UNLESS OTHERWISE INDICATED DOSE AFTER DIALYSIS) |
|---|---|
|
Isoniazid |
No adjustment necessary |
|
Pyrazinamide |
25-35 mg/kg per dose three times per week (not daily) |
|
Ethambutol |
15-25 mg/kg per dose three times per week (not daily) |
|
Levofloxacin |
750-1000 mg per dose three times per week (not daily) |
|
Moxifloxacin |
No adjustment necessary |
|
Ethionamide |
No adjustment necessary |
|
Clofazimine |
No adjustment necessary |
| Bedaquiline | No dosage adjustments required in patients with mild to moderate renal impairment (dosing not established in severe renal impairment, use with caution) |
|
Estimated creatinine clearance calculations: Men: Ideal Body Weight (kg) X (140 – age) / 72 X serum creatinine (mg/dl) Women: 0 85 X Ideal Body Weight (kg) X (140 – age) / 72 X serum creatinine (mg/dl) |
Resources
- Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, March 2021.
- WHO Consolidated Guidelines on Tuberculosis: Module 4 - Treatment: Drug-resistant TB Treatment, 2020.
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