Use of Isoniazid [H] Mono/Poly DR-TB Regimen in Special Situations

Treatment with Isoniazid (H) mono/ poly Drug-resistant Tb (DR-TB) regimen needs special considerations in certain special situations.

Pregnancy and Lactation

• In pregnant women, the H mono/ poly DR-TB regimen may be started or continued safely.
• For women of reproductive age, treated for H mono/ poly DR-TB, the use of Rifampicin (R) may interact with contraceptives resulting in decreased efficacy of protection against pregnancy.
• Alternative options recommended for contraception, if R is used are:
  • Use of an oral contraceptive pill containing a higher dose of estrogen (50 μg).
  • Use of other forms of contraception like barrier methods (e.g., condoms/ diaphragms), Intrauterine Devices (IUDs e.g., CuT) or depot-medroxyprogesterone (depo-provera) are recommended based on individual preference and eligibility.

Patients with Extensive Disease

The prolongation of the H mono/ poly DR-TB regimen to more than 6 months could be considered on an individual basis for patients with extensive disease up to a maximum of 12 months.

People Living with HIV (PLHIV)

• The H mono/ poly DR-TB regimen is recommended in HIV-reactive TB patients.
• In TB patients with HIV coinfection, the priority is to ensure that they are started on Antiretroviral Treatment (ART) within 8 weeks of TB treatment initiation (regardless of the CD4 count).

Extra-pulmonary Disease

• The treatment of patients with extra-pulmonary TB should be designed in close consultation with appropriate specialists (e.g., infectious disease physicians and neurologists) to decide upon individual variations in treatment duration and supportive care as needed.
• In the Central Nervous System (CNS), skeletal and miliary TB, treatment may be given up to a year.

Resources

• Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, March 2021.
• WHO Consolidated Guidelines on Tuberculosis: Module 4 – Treatment: Drug-resistant TB Treatment, 2020.

Kindly provide your valuable feedback on the page to the link provided HERE