Treatment of Drug-Resistant Tuberculosis

The presence of drug resistance should always be suspected when there are risk factors for it and must be confirmed by bacteriological or molecular tests for standardized drug sensitivity. Any regimen for drug-resistant TB is more likely to be effective if its composition is based on information from reliable drug susceptibility testing.

The presence of drug-resistant tuberculosis should be suspected in patients who are failing treatment, in patients with TB relapse, in subjects coming from regions with a high prevalence of MDR-TB, and in contacts of known cases of MDR-TB. Although there are multiple reasons why treatment may fail, the most frequent is the lack of adherence to the regimen.

The most common causes of relapse include lack of adherence to treatment with the development of acquired drug resistance, treatment with an inadequate therapeutic regimen, malabsorption of drugs, and exogenous reinfection with a different strain of M. tuberculosis.

In patients with confirmed rifampicin-susceptible and isoniazid-resistant tuberculosis, treatment with rifampicin, ethambutol, pyrazinamide, and levofloxacin is recommended for a duration of 6 months.

One general WHO recommendation is that all patients with rifampin-resistant TB (even those with monoresistance to rifampin) should be treated with an MDR-TB drug regimen. There are three options for the treatment of RR/MDR/XDR TB. Two are recommendations for programmatic management (the short and longer regimens) and one for operational research (the BPaL regimen).

Keywords: BPaL, Drug-resistant tuberculosis, Longer regimen, Short-course regimen, Treatment.BPaL, Drug-resistant tuberculosis, Longer regimen, Short-course regimen, Treatment.