Shorter Oral Bedaquiline-containing MDR/RR-TB Regimen: Drug Dose Administration

Drug dose administration for shorter/ longer oral Bedaquiline (Bdq)-containing Multidrug-resistant (MDR)/ Rifampicin-resistant (RR)-TB regimen depends on the factors described below.

• The dosage of second-line anti-TB drugs would vary as per the weight of the Drug-resistant TB (DR-TB) patients.​ There are five weight bands in adult patients (≥ 18 years): <16 kg, 16-29 kg, 30-45 kg, 46-70 kg and >70 kg. The weight bands of adult patients for Drug-sensitive TB (DS-TB) patients are different compared to DR-TB patients.
• All morning doses should be supervised by the treatment supporter via Directly Observed Treatment, Short-course (DOTS).​
• In patients with drug intolerance, Cycloserine (Cs), Ethionamide (Eto) and Sodium (Na) Para Aminosalicylic Acid (PAS), can be given in two divided doses.​ Pyridoxine should be provided as part of the regimen till the end of treatment for all patients. ​​

Change in Weight Bands during Treatment​

• For adult DR-TB patients whose weight increases or decreases by 5 kg or more compared to baseline weight and crosses the current weight band during the course of the treatment, the weight band must be changed at the time of issuing next month's box to the treatment supporter of the patient.
• For paediatric patients, the drug dosage should be adjusted immediately once the weight of the patient crosses the range of the weight band. Counsel the patient about the change in dose.

​Key Considerations for Newer Drugs ​

• Avoid milk-containing products with drugs: The calcium in the milk can decrease the absorption of Fluoroquinolones (FQs)​.
• Avoid large fatty meals: Fat impairs the absorption of anti-TB drugs (Cs, Isoniazid (H), etc.).​

Resources

• Guidelines for Programmatic Management of Tuberculosis in India, 2021.
• The Use of Bedaquiline in the Treatment of Multidrug-resistant Tuberculosis: Interim Policy Guidance, 2013