Shorter Mdr Regimen

Question 1

Goal of mdr tb rx

Answer 1

Break chain , decrease pool of cases
Decrease mortality
Minimize development and amplification of resistance

Question 2

Group a drugs

Answer 2

Mnemonic:LLB
Linezolid
Bedaquiline
Levo/moxi

Question 3

Group b

Answer 3

Clofa

cycloserine

Question 4

Group c

Answer 4

Ethambutol
Dlm
Z
Imi
Mero
Ami/streptomycin
Ethionamide/prothionamide
Pas

Mnemonic : 8 drugs
E² p² MAD

Question 5

Bedaquiline 
Group
Moa
Half life
Metabolism

Answer 5

Diarylquinolone
Atp synthatase inhibitor
Strong bactericidal and sterilizimg activities
5 n hlf month
Liver

Question 6

Delamanid
Group
Moa
T 1/2

Answer 6

Nitro dihydro imidazo oxazole
Inhibit mycolic acid and release no
36 hrs
Approved from 3-5

Question 7

If rifampicin resistance detected- whats the next step

Answer 7

Send second specimen to c&dst lab

FL and sl lpa +lc dst to moxi/ bdq/linid , clofa,dlm, z

Question 8

Exclusion criteria for shorter regimen

Answer 8

History of more than one month exposure to bdq/lfx/eto/cfz in absence of dst
Intolerance to any drug
Extensive tb
Severe eptb- miliary/ cns
In children- anything other than lymphnode (Peripheral or mediastinal without compression)
Pregnant/lactation
Below 5

Question 9

What is extensive tb

Answer 9

B/lcavity , extensive parenchymal damage

Under 15- cavities/ b/l disease

Question 10

Dst based inclusion criteria

Answer 10

RR
H resistance only inha or kat g not both
No fq resistance

Question 11

What will u do if u started longer mdr regimen based on h/o one month exposure n later found sensitive

Answer 11

Switch back to shorter orak regimen if duration of longer regimen taken is less than 1 month

Question 12

Pre treatment evaluation

Answer 12

H&p
Bmi
Rbs
Hiv
Lft/kft/tsh
Upt /ecg/cxr
Urine

Question 13

Regimen of shorter mdr

Answer 13

4-6 bdq⁶ , lfx, cfz,z,e,h, eto

5 lfx. Cfz , z ,e

Question 14

What are discontinued in continution phase

Answer 14

Hh , eto after 4 months

If intensive phase prolonged for 6 months bdq, eto , hh stopped together

Question 15

When do u extend the intensive phase in shorter mdr

Answer 15

Sputum positive in end of 4th month- send 1st and 2nd lpa and dst and prolong ip
If any resitance on that - longer regimen
Ip max 6 months
Cp is 5 months

Question 16

Inclusion and exclusion criteria for bdq

Answer 16

Inc: more than 5 and 15kg
Controlled stable arrythmia
Preg and lactation

Exc: uncontrolled cardiac arrhythmia
Qtc>500 and normal electrolytes , rpt after 6 hrs if still same
H/o: torsades de pointer

Question 17

Exclusion criteria for injectable shorter regimen

Answer 17

Dst based- h resistance but not both
Fq/sli resistance

Other: more than one month to km/am , mfx, eto or cfz
Other same as shorter mdr

Question 18

Injectable regimen

Answer 18

4-6 mfxh , km, eto , cfz , z , hh, e
5 mfx , cfz ,z ,e
Injection only 3/week if in extended ip

Question 19

Pre treatment and f/u for injectable

Answer 19

Audiometry q2 monthly till sli

S.creat basekinevand till sli

Question 20

How to administer

Answer 20

All drugs daily
Pyridoxine to all
Check weight band while issuing next month box
Pediatric patient- change immediately

Question 21

Dosage of Bedaquiline

Answer 21

400 od for 2 weeks

3-24 - 200 thrice weekly

Question 22

Meals in mdr tb and drugs to be avoided

Hiv drugs

Answer 22

Milk avoided-at same time- calcium decrease absorption of fq
Large fatty meals avoided
Cyp3a4 inhibitors- azole , rifamycins,statin
Bfq- efavirenz
Lopi/rito prolonged qt

Question 23

Replacememt sequence in shorter mdr

Answer 23

No replacement

Question 24

Follow up in shorter mdr
Microscopy
Culture
Dst
Cxr,tft,lft
Ecg

Answer 24

Smear- monthly from 3rd till end of ip/extended ip
Culture- 3,6,end of rx 
If 6 positive- rpt immediately 
Dst- if Culture pos at 3 or later
If sm pos at end of ip or later

At end of ip
Ecg- at 2 weeks , then monthly in first 6 months

Question 25

If end of 6 months , positive. It is labelled as

Answer 25

Failure

Once red with shorter mdr for more than month, never reinitiate

Question 26

When do u do the foloow up cultures

Answer 26

6,12, 18,24 post treatment

Question 27

Pregnancy and lactation, which frugs to be avoided

Answer 27

Ethionamide in first 32 weeks- so no shorter regimen

Hypothyroidism in baby

Question 28

Art in dr-tb

Answer 28

Cpt for everyone

First att and then art

Question 29

Iris syndrome

Answer 29

Temporary exacerbation after getting better.. radiology, symptoms , nodes
Diagnosis of exclusion
Prednisone for 1-2 weeks

Question 30

What is the role of surgery

Answer 30

If unilateral resectable disease
-absence of clinical/radio response after treating for 6-9 months
High risk of failure due to resistance
Morbid complications- hemo, extasis, fistula , empyema
Relapse after completing treatment

Question 31

Drugs needing modification in renal failure in crcl<30 and on HD

Answer 31

Z- 25-35mg/kg thrice weekly
E15-25 mg/kg thrice weekky
L 750-1000

L can be replaced with normal dose mfx(200/400)

Question 32

Pre existing liver diease and shorter mdr

Answer 32

Hepatotoxic drugs- h,z, eto , bdq
Rarely- fq

Exclude other etiologies like viral

Shorter mdr avoided

Question 33

Seizure disorder and s-mdr regimen

Psychiatric disorder

Answer 33

Make sure if seizure is controlled , wether on anti epileptics

Eto and fq- seizures

Psy- h. Fq, eto
Pyridoxine prophylaxis

Question 34

Drugs causing qt prolongation
Psychotic
Tendon rupture
Hypothyroid
Hepatatits

Answer 34

Bdq, fq, cfz
H, fq
Fq
Eto
Z,h, eto , bdq