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Table 1 shows the sequence of using replacement drugs to modify the longer oral multi (M)/extensively drug-resistant TB (XDR-TB) regimen. The physician at the nodal and district DR-TB centres (N/DDR-TBC) should use this table to replace the drugs to modify the regimen.
|
Sr. No |
Drugs to be replaced |
Number of drugs to include from |
Final regimen after replacement |
||
|---|---|---|---|---|---|
|
Group A (3 drugs) |
Group B (2 drugs) |
Group C (7 drugs) |
|||
|
1 |
None$ |
3 |
2 |
- |
6-8 Levofloxacin (Lfx), Bedaquiline (Bdq), Linezolid (Lzd), Clofazimine (Cfz), Cycloserine (Cs) / 12 Lfx, Lzd, Cfz, Cs |
|
2 |
1 group A drug@ |
2 |
2 |
1 |
No FQ, then 6-8 Bdq, Lzd, Cfz, Cs, Delamanid (Dlm) / 12 Lzd, Cfz, Cs
No Bdq, then 6-8 Lfx*, Lzd, Cfz, Cs, Dlm / 12 Lfx*, Lzd, Cfz
No Lzd, then 6-8 Lfx*, Bdq, Cfz, Cs, Dlm / 12 Lfx* Cfz, Cs |
|
3 |
1 group B drug |
3 |
1 |
1 |
No Cfz, then 6-8 Lfx* Bdq,Lzd, Cs, Dlm / 12 Lfx* Lzd, Cs
No Cs, then 6-8 Lfx* Bdq, Lzd, Cfz, Dlm / 12 Lfx* Lzd, Cfz |
|
4 |
1 group A drug@ and 1 group B drug |
2 |
1 |
2 |
No Fluoroquinolone (FQ) and Cfz then 6-8 Bdq, Lzd, Cs, Dlm, Amikacin (Am)# / 12 Lzd, Cs, Pyrazinamid (Z)#, Ethionamide (Eto)#
No FQ & Cs then 6-8 Bdq, Lzd, Cfz, Dlm, Am# / 12 Lzd, Cfz, Z#, Eto#
No Bdq & Cfz then 6-8 Lfx* Lzd, Cs, Dlm, Am# / 12 Lfx* Lzd, Cs
No Bdq & Cs then 6-8 Lfx* Lzd, Cfz, Dlm, Am# // 12 Lfx* Lzd, Cfz
No Lzd & Cfz then 6-8 Lfx* Bdq, Cs, Dlm, Am# // 12 Lfx*, Cs, Z#, Eto#
No Lzd & Cs then 6-8 Lfx* Bdq, Cfz, Dlm, Am# / / 12 Lfx*, Cfz, Z#, Eto |
|
5 |
2 group A drugs@ |
1 |
2 |
2 |
No FQ & Bdq then 6-8 Lzd, Cfz, Cs, Dlm, Am# / 12 Lzd, Cfz, Cs, Z#
No FQ & Lzd then 6-8 Bdq, Cfz, Cs, Dlm, Am# / 12 Lfx*, Cs, Z#, Eto#
No Bdq & Lzd then 6-8 Lfx*, Cfz, Cs, Dlm, Am# /12 Lfx*, Cfz, Cs, Z# |
|
6 |
2 group B drugs |
3 |
0 |
2 |
No Cfz & Cs then 6-8 Lfx* Bdq, Lzd, Dlm, Am# / 12 Lfx*, Lzd, Z#, Eto# |
|
$ No replacement required if any one drug is dropped in the last 12 months of treatment. @ FQs would be counted together as one drug of group A if neither Lfx nor Mfx(h) can be used. * if Lfx can’t be used, use Mfx(h) if second-line-line probe assay (SL-LPA) pattern suggests and continue if Mfx(1.0) sensitive on lab culture (LC) & Drug Susceptibility Test (DST). # if sensitive on LPA or LC&DST, inhA mutation would indicate Eto resistance. If resistance detected, then the drugs to be used in the order of Dlm, Am#, Z#, Eto#, PAS, E and as a final resort Imipenem / Cilastatin (Imp/Cls) or Meropenem (Mpm) in combination with Amoxiclav. Dlm & Am may not be introduced after initial 8 months of treatment and during this later phase the replacement sequence would be Z#, Eto#, p-aminosalicylic acid (PAS), Ethambutol (E). |
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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 [Internet], 2020
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