Algorithms for Programmatic Management of Drug-Resistant TB.pdf
1.
PROGRAMMATIC MANAGEMENT OFDRUG-RESISTANT TUBERCULOSIS
PROGRAMMATIC MANAGEMENT OF DRUG-RESISTANT TUBERCULOSIS
MTB detected
Trace (TT)
Repeat Ultra
assay using fresh
specimen
MTB DETECTED, RIF RESISTANCE DETECTED (RR)
MTB DETECTED, RIF RESISTANCE NOT DETECTED (T)
MTB DETECTED, RIF RESISTANCE INDETERMINATE (TI)
MTB NOT DETECTED (N)
NO RESULT, ERROR, OR INVALID RESULT (I)
MTB detected
Trace (TT)
MTB not
detected (N)
ALGORITHM 1. XPERT MTB/RIF ULTRA TEST RESULTS INTERPRETATION AND TREATMENT DECISIONS
Refer to R-TB MAC for possible initiation of DR-TB
treatment if presumptive DR-TB
or
Initiate first-line drugs for presumptive DS-TB
MTB DETECTED, RIF RESISTANCE DETECTED (RR)
MTB DETECTED, RIF RESISTANCE NOT DETECTED (T)
MTB DETECTED, RIF RESISTANCE INDETERMINATE (TI)
MTB NOT DETECTED (N)
NO RESULT, ERROR, OR INVALID RESULT (I)
Follow NTP-MOP interpretation
similar to Xpert-MTB RIF
2.
PROGRAMMATIC MANAGEMENT OFDRUG-RESISTANT TUBERCULOSIS
PROGRAMMATIC MANAGEMENT OF DRUG-RESISTANT TUBERCULOSIS
Treat with
DS-TB
regimen
XPERT MTB/RIF TEST (DSSM/TB LAMP, IF XPERT TEST NOT AVAILABLE)
ALGORITHM 2. DIAGNOSIS AND CLINICAL APPLICATION OF XPERT MTB/RIF
MTB+/No RR MTB+ & RR Invalid/Error
/Indeterminate
MTB not
detected (N)
High-risk for
MDR-TB
Low-risk for
MDR-TB
Recollect/
repeat Xpert
MTB/RIF test
and follow 2nd
test result
Start with standard
regimen or ITR after
checking eligibility
Revise regimen if
FQ and/or SLI
resistant (+). Refer
to TB MAC if
needed
Collect 2 sputum
examples and do LPA-SLA
DST, C& DST test at
baseline
NEW CASE
Clinical F/U
If still
suspicious of
TB-
if no CXR
-Antibiotic trial
-Do any other
investigation
relevant to
EPTB
-Refer to TB
MAC for
possible start
anti-TB
treatment
Clinical F/U
If not
suspicious of
TB- but still has
S/S- ivestigate
for other
medical
condition
-Start LTBI
treatments for
contacts of
bacteriologically
confirmed TB
case
3.
PROGRAMMATIC MANAGEMENT OFDRUG-RESISTANT TUBERCULOSIS
PROGRAMMATIC MANAGEMENT OF DRUG-RESISTANT TUBERCULOSIS
PATIENT DIAGNOSED AS RR/MDR-TB
ALGORITHM 3. ASSIGNMENT OF DR-TB REGIMEN
Collect 3 sputum specimens for LPA/Xpert XDR,
SM, TBC and DST
Check exclusion criteria to BPaLM
NO to all
YES to any
Check general exclusion criteria to SSOR
YES to any
NO to all
Consult with TB
MAC for ITR
Start SSOR
Start BPaLM
Confirmed Fq
resistance
Pregnancy/
breastfeeding
without:
Hgb <8, severe
peripheral
neuropathy and any
sign of optic neuritis
on baseline
No Fq
resistance
Continue as
BPaL
Continue
BPaLM
with:
Hgb <8, severe
peripheral
neuropathy and any
sign of optic neuritis
on baseline
Start SSOR w/ Lzd Start SSOR w/ Pto
Check results of Xpert-XDR, first-line and second line LPA
and phenotypic DST
