II. Indications

  1. Resistant to at least Isoniazid and Rifampin

III. 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

IV. 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

V. 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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