XDR TB - What should be the treatment regimen now?

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XDR TB - What should be the treatment regimen now?

Author: Pediatric Oncall

Question
A 6 years old boy had non-resolving pneumonia. His bronchoalveolar lavage (BAL) showed the presence of acid-fast bacillus (AFB) on the smear. He was started on 4 drugs antituberculous therapy (ATT) consisting of Isoniazid (H), Rifampicin (R), Pyrazinamide (Z), and Ethambutol (E). Chest X-Ray showed right paracardiac haziness with mediastinal adenopathy. Culture of BAL after 6 weeks grew mycobacterium tuberculosis (MTB) which was resistant to HRZE, Streptomycin (S), Amikacin (Am), Ofloxacin (Ofx), high-dose Moxifloxacin (mfx), Capreomycin and sensitive to Ethionamide (Eto), PAS, Clofazimine (Cfz). He was started on Eto, PAS, Cfz and also was given mfx, HE. He also was suffering from hereditary spherocytosis and distal renal tubular acidosis (RTA). He referred to us after 18 months of the above treatment in view of sputum still being AFB positive and chest X-Ray showing fibrocavitatory TB. His paternal aunt had died due to TB 2 years back.

What should be the treatment regimen now?

Answer Discussion :

A

anulika chiemela

0

Bedaquillie

P

padamati govardhan

1

This is a typical case of XDR -TB can extend treatment up to 24 months and consider ,consider giving newer drugs such as BAD-AQUILINE,or DELAMANIDE. RESECTIVE SURGERY IS disease is localised

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Answer 1

A repeat culture DST should be done and in the meantime Bedaquilline, Delaminid combination along with salvage therapy should be started.

XDR TB - What should be the treatment regimen now?

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