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ULY CLINIC
ULY CLINIC
21 Mei 2026, 14:49:24
Drug-Resistant Tuberculosis (DR-TB)
Drug Resistant Tuberculosis (DR-TB) is a laboratory diagnosis confirmed after testing Mycobacterium tuberculosis strains for resistance using WHO-recommended rapid genotypic tests such as GeneXpert or conventional phenotypic culture and Drug Susceptibility Testing (DST).
Clinical Presentation
The clinical features are similar to drug-susceptible tuberculosis; however, the patient shows resistance to first-line anti-TB treatment.
Common Signs and Symptoms
Persistent cough
Blood-stained sputum
Fever
Night sweats
Weight loss
Presumptive DR-TB Patients (High-Risk Groups)
Patients with the following features are considered at high risk for DR-TB:
History of Previous TB Treatment
Treatment failure after using first-line anti-TB medicines
Relapse or return after loss to follow-up without recent treatment failure
Patients remaining sputum smear-positive at month two or later during treatment with first-line anti-TB medicines
Other High-Risk Groups
Close contact with a known DR-TB case
Healthcare workers presenting with TB symptoms
Vulnerable groups in congregate settings:
Prisoners
Urban poor
Miners
PWIDs (People Who Inject Drugs)
All presumptive DR-TB cases in both adults and children must receive the Xpert MTB/RIF test as the initial diagnostic test to ensure universal coverage of DST.
Pharmacological Treatment
When RR/MDR-TB is diagnosed, communicate immediately with the District Tuberculosis and Leprosy Coordinator (DTLC) for treatment initiation.
Table 7.4: Proposed MDR-TB Treatment Regimens
Age Group | Patient Condition | Intensive Phase | Continuation Phase* | Alternative Medicines (Based on DST, Prior Use, and Likelihood of Efficacy) |
Adults and children >12 years | MDR/RR-TB susceptible to fluoroquinolone | 6 Lfx + Bdq + Lzd + Cfz + Cs | 12 Lfx + Cfz + Cs | E, Z, Pto, PAS |
Adults and children >12 years | MDR/RR-TB with resistance to fluoroquinolone (pre-XDR) or extensive drug resistance (XDR-TB) | 6 Bdq + Lzd + Cfz + Cs + Dlm | 14 Lzd + Cfz + Cs | E, Z, Pto, PAS |
Adults and children >12 years | Central nervous system disease | 6 Lfx + Lzd + Cs + Pto + Z | 14 Lfx + Lzd + Cs + Z | INH-HD (if low-level H resistance – inhA mutation)¹ |
Pregnant RR/MDR-TB | Pregnant patients | 20 Lfx + Cs + E + Cfz + Z | — | Consult DR-TB Consilium for all pregnant cases. Consider strengthening the regimen postpartum with addition of Bdq and Lzd for 6 months to replace Class C medicines where possible. |
Table 7.5: Paediatric Treatment Regimens for Children <12 Years with Non-Severe Disease
Children 6–12 Years
Patient Condition | Intensive Phase | Continuation Phase* | Alternative Medicines |
RR/MDR-TB susceptible to fluoroquinolone | 6 Lfx + Bdq + Lzd + Cs | 3 Lfx + Lzd + Cs | Cfz, Dlm¹, E (if documented sensitivity), Z (Cfz preferred over Cs if 50 mg capsule available) |
RR/MDR-TB with resistance to fluoroquinolone (pre-XDR) or XDR-TB | 6 Bdq + Lzd + Cs + PAS | 3 Lzd + Cs + PAS | Cfz, Dlm¹, E (if documented sensitivity), Z (Cfz preferred over PAS if 50 mg capsule available) |
Children 3–6 Years
Patient Condition | Proposed Regimen | Alternative Medicines |
RR/MDR-TB susceptible to fluoroquinolone | 9 Lfx/Mfx + Lzd + Cs + Eto | Cfz, Dlm¹, PAS, E (if documented sensitivity), Z |
RR/MDR-TB with resistance to fluoroquinolone | 6 Lzd + Cs + Dlm¹ + Eto → 3 Lzd + Cs + Eto | Cfz, PAS, E (if documented sensitivity), Z |
Eto should not be used if inhA mutation is present.Cfz is preferred over Eto if 50 mg capsule is available.
Children <3 Years
Patient Condition | Proposed Regimen | Alternative Medicines |
RR/MDR-TB susceptible to fluoroquinolone | 9 Lfx/Mfx + Lzd + Cs + Eto | Cfz, PAS, E (if documented sensitivity), Z |
RR/MDR-TB with resistance to fluoroquinolone | 6 Lzd + Cs + PAS + Eto → 3 Lzd + Cs + PAS | Cfz, Dlm¹, E or Z (if documented sensitivity) |
Eto should not be used if inhA mutation is present.Cfz is preferred over Eto if 50 mg capsule is available.
Table 7.6: Modified Short Treatment Regimen
Age Group | Patient Condition | Intensive Phase | Continuation Phase |
15 years and above | Patient eligible for short treatment regimen | 6 Bdq + Lzd + Lfx + Cfz + Cs + Z | 3–5 Lfx + Cfz + Cs + Z |
15 years and above | Patient eligible for short treatment regimen but cannot tolerate Linezolid (Hb <8 g/dL, neutrophils <0.75 × 10⁹/L, platelets <50 × 10⁹/L, severe peripheral neuropathy grade ≥2, or optic neuritis grade ≥2 at baseline) | 6 Bdq + Dlm + Lfx + Cfz + Cs + Z | 3–5 Lfx + Cfz + Cs + Z |
Abbreviations
Abbreviation | Meaning |
Lfx | Levofloxacin |
Mfx | Moxifloxacin |
Bdq | Bedaquiline |
Lzd | Linezolid |
Cfz | Clofazimine |
Cs | Cycloserine |
Dlm | Delamanid |
Eto/Pto | Ethionamide/Prothionamide |
PAS | Para-aminosalicylic acid |
E | Ethambutol |
Z | Pyrazinamide |
INH-HD | High-dose Isoniazid |
RR-TB | Rifampicin-Resistant Tuberculosis |
MDR-TB | Multidrug-Resistant Tuberculosis |
XDR-TB | Extensively Drug-Resistant Tuberculosis |