TB and NTM

Question 1

What are risk factors for drug resistant TB (MDR/RR-TB or XDR-TB)?

Answer 1

Sputum AFB +ve (not very good predictor), lung cavity, history of previous TB, history of previous TB treatment. In particular relapse after/during treatment, or defaulting on treatment are a concern. There is also geographical variation in drug resistant TB with higher rates in eg South Africa, Pakistan, India, Russia, China, Indonesia, North Korea and the Phillipines

Question 2

In what situation is the TB drug regime 2HRZE/4HR recommended?

Answer 2

This is standard TB treatment, recommended for limited, fully sensitive pulmonary TB. Current recommendations now (2024) recommend the shorter 2HPZM/2HPM regime but access to Rifapentin is a problem so this regime has not been widely adopted yet.

H=Isoniazid R=Rifampicin P=Rifapentin Z=Pyrazinamide E=ethambutol M=Moxifloxacin

Question 3

In what situation is the TB drug regime 2HRZE/10HR recommended?

Answer 3

CNS infection (fully sensitive organism)

H=Isoniazid R=Rifampicin Z=Pyrazinamide E=ethambutol

Question 4

In what situation is the TB drug regime 2HRZES/1HRZE/5HRE recommended?

Answer 4

This is one option for TB treatment after treatment interruption, if there was a low risk of MDR-TB based on geography and patient factors.

H=Isoniazid R=Rifampicin Z=Pyrazinamide E=ethambutol S=streptomycin

Question 5

In what situation is the TB drug regime 6REZLx recommended?

Answer 5

In DR-TB (R susceptible, H-resistant) treatment with rifampicin, ethambutol, pyrazinamide and levofloxacin is recommended for a duration of 6 months.

R=Rifampicin Z=Pyrazinamide E=ethambutol Lx=levofloxacin

Question 6

In what situation is the TB drug regime 6 Bdq -Lfx-Cfz-Z-E-Hh-Eto / 5 Lfx-Cfz-Z-E recommended?

Answer 6

This is an example of an all-oral regime for MDR/RR-TB not resistant to fluoroquinolones

Bdq=bedaquiline Lx=levofloxacin Cfz= Z=Pyrazinamide E=ethambutol Hh= high dose isoniazid Eto=Ethionamide

Question 7

What is the recommended treatment regime for latent TB?

Answer 7

3HR or 6H

H=Isoniazid R=Rifampicin

Question 8

What is the standard treatment regime for fully sensitive pulmonary TB (Mycobacterium Tuberculosis)?

Answer 8

2HRZE/4HR

Current recommendations now (2024) recommend the shorter 2HPZM/2HPM regime but access to Rifapentin is a problem so this regime has not been widely adopted yet.

H=Isoniazid R=Rifampicin P=Rifapentin Z=Pyrazinamide E=ethambutol M=Moxifloxacin

Question 9

What does a positive GeneXpert-MTB/RIF test indicate?

Answer 9

A positive GeneXpert-MTB/RIF test indicates resistance to rifampicin. This is a proxy for MDR-TB.

Question 10

What is the first line treatment regime recommended for RR-MTB with fluoroquinolone resistance?

Answer 10

6-Bdq-Pa-Lzd