Eligibility Criteria for Longer Oral M/XDR-TB Regimen

Longer oral Multi (M)/ Extensively-drug Resistant TB (XDR-TB) regimen is recommended for Multi-drug Resistant (MDR)/ Rifampicin-resistant TB (RR-TB) patients who are excluded from shorter oral Bedaquiline-containing MDR/ RR-TB regimen including for the XDR-TB patient. 

A patient would be re-evaluated in any of the following conditions and initiated on a longer oral M/XDR-TB regimen at Nodal (N)/ District DR-TB Centre (DDR-TBC) with any modifications:

• Additional resistance
• Intolerance or non-availability of any drug in use 
• Emergence of exclusion criteria 
• Return after lost-to-follow-up (LTFU) 
• Failed to shorter oral Bedaquiline-containing MDR/ RR-TB regimen or any longer regimen 

The decision will also be based on Drug Susceptibility Test (DST) results, especially for Levofloxacin (Lfx), Moxifloxacin (Mfx), Bedaquiline* (Bdq), Linezolid (Lzd), Clofazimine* (Cfz), Delamanid* (Dlm) and Pyrazinamide (Z) (*whenever available).

The regimen modification would be done using a replacement of the sequence from group C drugs.

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.

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