11.1 Introduction

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المحتويات

     

     

    Rifampicin-susceptible and isoniazid-resistant tuberculosis (Hr-TB) treatment is indicated in children and adults with pulmonary TB (PTB) and extrapulmonary TB (EPTB) when:   

    • Susceptibility to rifampicin is confirmed by drug susceptibility testing (DST) and resistance to isoniazid is confirmed by DST, 

    or  

    • Susceptibility to rifampicin is confirmed by DST and resistance to isoniazid is strongly suspected (i.e. household or close contacts of a patient with confirmed Hr-TB), while waiting for DST results for isoniazid, or if susceptibility to isoniazid cannot be tested. 

     

    Patient with Hr-TB should be treated with the standard Hr-TB regimen [1] Citation 1. Fregonese F et al. Comparison of different treatments for isoniazid-resistant tuberculosis: an individual patient data meta-analysis. Lancet Respir Med. 2018 Apr;6(4):265-275. [2] Citation 2. World Health Organization. WHO operational handbook on tuberculosis. Module 4: treatment - drug-resistant tuberculosis treatment, 2022 update. Geneva; 2022.
    https://www.who.int/publications/i/item/9789240006997
    when:   

    • Susceptibility to fluoroquinolones is confirmed 

    and, if possible  

    • Susceptibility to pyrazinamide is confirmed. 

     

    Notes:  

    • Fluoroquinolone resistance can be detected at the same time as isoniazid resistance by a rapid molecular test (Xpert MTB/XDR).  
    • Pyrazinamide resistance is detected by more complex tests (phenotypic DST or Genoscholar PZA-TB ll) that cannot always be performed, or for which the results are not available at the start of treatment. 
    • Susceptibility to ethambutol cannot be confirmed as there is no reliable DST.   

     

    Other regimens should be considered for patients with additional resistance, contraindication or intolerance to fluoroquinolones and/or pyrazinamide.  

     

    المراجع
    • 1.Fregonese F et al. Comparison of different treatments for isoniazid-resistant tuberculosis: an individual patient data meta-analysis. Lancet Respir Med. 2018 Apr;6(4):265-275.
    • 2.World Health Organization. WHO operational handbook on tuberculosis. Module 4: treatment - drug-resistant tuberculosis treatment, 2022 update. Geneva; 2022.
      https://www.who.int/publications/i/item/9789240006997