Problems of treatment interruption by the patient (e.g. discontinuation of certain drugs, recurrent treatment interruptions) should be detected and addressed (management of adverse effects if necessary and reinforcement of patient support measures).
Interruptions of individual drug(s) or of the whole treatment may lead to the emergence of new resistances.
Moreover, in case of treatment interruption, drugs with a long half-life such as bedaquiline or clofazimine remain in the blood for several months. In practice, it is as if the patient is receiving bedaquiline and/or clofazimine alone, which increases the risk of developing resistance to these drugs.
Patients who have interrupted the whole treatment for 2 months or more meet the definition of patients “lost to follow-up” (Chapter 17). If the patient returns, repeat bacteriological tests (RMTs, culture and full pDST or genome sequencing) to detect potential new resistance; start a new individualized regimen.
For patients who have interrupted the whole treatment for 4 weeks or more but less than 2 months, perform new bacteriological tests as above. Further treatment depends on the results of the RMTs (pending full bacteriological tests results) and the patient's clinical status: new individualized regimen or continuation of the same regimen with catch-up of doses missed during interruptions to complete treatment.
For patients on BPaLM/BPaL who have interrupted the whole treatment for 2 weeks or more, perform new bacteriological tests as above and start a new individualized regimen.