DR-TB

Question 1

What are the advices for pregnant DR-TB pts

Answer 1

1) All child-bearing age female pts need to be screened for pregnancy
2) Rx should be started promptly, but may be delayed until second trimester if stable with minimal disease
3) Injectables (Am & Sm) contraindicated. Capreomycin is acceptable
4) Ethionamide (Eto) containdicated (teratogenic & severe N/V)
5) TOP in life-threatening condition

Question 2

What are the types of DRTB?

Answer 2

Mono-resistance: resistant to H or E or Z
Poly resistance: resistant to E & Z
MDR: resistant to H & R
XDR: resistant to H & R & fluoroquinolones + Bedaquiline or Linezolid
Pre-XDR: resistant to H & R & fluroquinolones
RR: resistant to R

Question 3

What are the options for MDR-TB regimen?

Answer 3

3 options:
1) Short regimen: Bdq-containing & Non-Bdq regimen
2) Long regimen: WHO 2020 new grouping & WHO 2016old grouping / Msia CPG 2016
3) BPaL - under research

Question 4

What are the options for short regimen for MDR/RR-TB Rx? (9-11m duration)

Answer 4

1) Bdq-containing regimen (all oral):
6Bdq + 4-6 Lfx/Mfx-Cfz-Z-E-Hh-Eto, then
5 Lfx/Mfx-Cfz-Z-E

2) Non-Bdq regimen (Bangladesh regimen):
4-6 Am-Mfx-Cfz-Z-E-Hh-Eto, then
5 Mfx-Cfz-Z-E

Question 5

What are the options for long regimen for MDR/RR-TB

Answer 5

1) Based on WHO 2020 new grouping:

2) Based on WHO 2016 old grouping/ 2016 CPG Malaysia: (choose 5 agents)
Choose 1 group A: Lfx/ Mfx
Choose 1 group B: Km/ Am
Choose ≥2 group C: Eto/ Cs/ Lzd/ Cfz
Choose group D1: Z/ E/ Hh
If minimum 5 agents cannot be achieve from above, then choose from group D2 (Bdq/ delamanid) or group D3 (PAS/ Imi/Mero + clavulanic acid)

Question 6

LTBI Rx for DRTB contacts

Answer 6

In RR-TB contact - LTBI Rx would be 6m H