Longer Mdr Regimen

Question 1

Eligibility criteria

Answer 1

Excluded from shorter mdr

Question 2

Regimen

Answer 2

18-20 lfx bdq lzd cfz cs
Mnemonic- 2L , 2C, B

Bdq for 6months , and beyond as an exception
Linezolid 300 od after 6-8 months

Question 3

Dose of delamanid

Answer 3

50mg bd for 24 wks in 6-11yrs

100mg bd for 24 wks for >12 yrs

Question 4

When do u extend the treatment
Linid
Bdq

Answer 4

Decision to taper linid after 6month depends on c/s , if positive extend max up to 8 months
If 8 positive - dst- if any resistance- modify accordingly
Bdq-6 months and only extended if no other drugs available to make proper regimen
Max is 20 months , not more than that

Question 5

Dlm with arv , dose modification

Answer 5

Trail 213 , not needed

Question 6

Replacement sequence

Answer 6

Initial 4-5 months atleast 4-5 drugs
Mnemonic:DAZE² PENEMS
ethionamide first.

Bdq+dlm- if no appropriate regimen

Delamanid and amikacin- no in last 12 months
In final 12 months atleast 3-4 drugs from a and b should be used

Last resort- bpal

No replacement required if one drug in last 12 months

Inha mutation- eto

Question 7

Replacemebt sequence after 12 months

Answer 7

Zepe

Question 8

Mdr tb in children

Answer 8

Dlm/bdq not approved under 5
So longer regimen according to replacement sequence
Injectables as last resort

Question 9

When do u monitir creat if pt is on amikacin

Answer 9

Monthly for 3 months

F/b every three months till on amikacin

Question 10

Drugs needing dose modification in renal failure

Answer 10

Pzd
Lfx
Ami

Cycloserine- 250 od or 500 tds
Pas- 4g/dose.  Bd max
Amoxiclav- 1gm bd if 10-30
Od if <10
Imipenem 20-40- 500 tds
<20- 500 bd
Mero- 20-40 750 bd
<20 - 500 bd

Question 11

Hepatotoxic

Answer 11

R
H
Eto
Pas
Bdq

Question 12

Bpal regimen

Exclusion

Answer 12

6-9 bdq, pretomanid , linezolid

Exposure less than 2 weeks

Question 13

Dosage of bpal

Answer 13

Pretomanid- 200 od for 26 wks
Bdq- 400 od for 2 wks
200 thrice/wk
Linid- 1200 od for 24 wks

Extend to 39 wks if culture positive at week 16