Pulmonology Book

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Multiple Drug Resistant Tuberculosis Treatment

Aka: Multiple Drug Resistant Tuberculosis Treatment, Multiple Drug Resistant Tb Treatment
  1. See Also
    1. Tuberculosis
    2. Latent Tuberculosis Treatment
    3. Active Tuberculosis Treatment
    4. Susceptible Tuberculosis Treatment
    5. Possibly Resistant Tuberculosis Treatment
    6. Tuberculosis Screening in Children
    7. Tuberculosis Risk Factors (Tuberculosis Screening Indications)
    8. Tuberculosis Risk Factors for progression from Latent to Active Disease (Latent Tuberculosis Treatment Indications)
    9. Tuberculosis Related Chest XRay Changes
    10. Extrapulmonary Tuberculosis
    11. Tuberculin Skin Test (TST, Purified Protein Derivative, PPD)
    12. Mycobacterium Tuberculosis Antigen-Specific Interferon-Gamma Release Assay (IGRA)
    13. Tuberculosis Resources
  2. Indications
    1. Resistant to at least Isoniazid and Rifampin
  3. Approach
    1. Treat with 3 or more drugs to which Tb is sensitive
    2. Consider starting 5-7 drugs before susceptibility known
      1. Indicated for high risk or previously treated Tb
    3. Continue Rx for 12-24 months after Cultures negative
    4. Parenteral drugs may increase rate of cure
    5. Lung resection with medications may increase cure rate
  4. Precautions
    1. This protocol is from 2003 without available new guidance to use for update as of 2016 review
    2. Multi-drug resistance requires expert local opinion for guidance
  5. Management
    1. Standard Main Drugs
      1. Isoniazid (INH)
      2. Rifampin
      3. Ethambutol
      4. Pyrazinamide
    2. Secondary additional drugs
      1. Aminoglycoside or Capreomycin
      2. Ciprofloxacin or Ofloxacin
      3. Cycloserine, Ethionamide, or para-aminosalicylic acid

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