Use of Shorter Oral Bedaquiline-containing MDR/RR-TB Regimen in Special Situations

Compared to Drug-sensitive TB (DS-TB), Drug-resistant TB (DR-TB) is more challenging  in terms of:​

• Cost of treatment​
• Duration of treatment​
• Higher adverse events to second-line drugs​
• Resources required by treatment providers​
• Prolonged adherence required by patients​

DR-TB patients with associated special situations make the treatment more difficult and need specialist interventions.​ Dose adjustment/ regimen modification is required in these special situations and needs specialist intervention from DR-TB centre.​ Accordingly, the regimen needs to be changed/ modified and informed to field staff.​ 

In real field scenarios at primary health center and district level, unavailability of specialists and delays in receiving recommendations/ approval from DR-TB committee might delay treatment.​ 

Considering these factors more attention needs to be given while treating DR-TB patients with the following special situations:​

• Pregnancy and lactation​
• People living with HIV​
• Role of surgery in DR-TB​
• Renal impairment​
• Pre-existing liver disease​
• Seizure disorders​
• Psychiatric illness​
• Severe form of Extra-pulmonary TB (EP-TB) and TB Meningitis​

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.
• Technical and Operational Guidelines for TB in India, 2016.

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