Shorter Mdr Regimen Flashcards
Goal of mdr tb rx
Break chain , decrease pool of cases
Decrease mortality
Minimize development and amplification of resistance
Group a drugs
Mnemonic:LLB
Linezolid
Bedaquiline
Levo/moxi
Group b
Clofa
cycloserine
Group c
Ethambutol Dlm Z Imi Mero Ami/streptomycin Ethionamide/prothionamide Pas
Mnemonic : 8 drugs
E² p² MAD
Bedaquiline Group Moa Half life Metabolism
Diarylquinolone Atp synthatase inhibitor Strong bactericidal and sterilizimg activities 5 n hlf month Liver
Delamanid
Group
Moa
T 1/2
Nitro dihydro imidazo oxazole
Inhibit mycolic acid and release no
36 hrs
Approved from 3-5
If rifampicin resistance detected- whats the next step
Send second specimen to c&dst lab
FL and sl lpa +lc dst to moxi/ bdq/linid , clofa,dlm, z
Exclusion criteria for shorter regimen
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
What is extensive tb
B/lcavity , extensive parenchymal damage
Under 15- cavities/ b/l disease
Dst based inclusion criteria
RR
H resistance only inha or kat g not both
No fq resistance
What will u do if u started longer mdr regimen based on h/o one month exposure n later found sensitive
Switch back to shorter orak regimen if duration of longer regimen taken is less than 1 month
Pre treatment evaluation
H&p Bmi Rbs Hiv Lft/kft/tsh Upt /ecg/cxr Urine
Regimen of shorter mdr
4-6 bdq⁶ , lfx, cfz,z,e,h, eto
5 lfx. Cfz , z ,e
What are discontinued in continution phase
Hh , eto after 4 months
If intensive phase prolonged for 6 months bdq, eto , hh stopped together
When do u extend the intensive phase in shorter mdr
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
Inclusion and exclusion criteria for bdq
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
Exclusion criteria for injectable shorter regimen
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
Injectable regimen
4-6 mfxh , km, eto , cfz , z , hh, e
5 mfx , cfz ,z ,e
Injection only 3/week if in extended ip
Pre treatment and f/u for injectable
Audiometry q2 monthly till sli
S.creat basekinevand till sli
How to administer
All drugs daily
Pyridoxine to all
Check weight band while issuing next month box
Pediatric patient- change immediately
Dosage of Bedaquiline
400 od for 2 weeks
3-24 - 200 thrice weekly
Meals in mdr tb and drugs to be avoided
Hiv drugs
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
Replacememt sequence in shorter mdr
No replacement
Follow up in shorter mdr Microscopy Culture Dst Cxr,tft,lft Ecg
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
