11.3 Other treatment regimens

There are no evidence-based treatment recommendations for patients with Hr-TB and additional resistance. The following regimens are examples of regimens that can be used under operational research conditions.

For more information on operational research conditions, see Chapter 10.

11.3.1 Additional resistance to levofloxacin

Box 11.2 – Regimen composition for levofloxacin-resistant Hr-TB

To avoid the combination of isoniazid and linezolid (increased risk of peripheral neuropathy), the FDC (HRZE) should not be used.

• If linezolid is stopped due to adverse effects:
  • before the end of Month 4: replace linezolid with delamanid until the end of treatment.
  • after the end of Month 4: based on clinical and bacteriological evolution, determine on a case-by-case basis if it is preferable to continue RZE only, or to replace linezolid with delamanid until the end of treatment.
• If linezolid is contraindicated, use the regimen 6RZE-Dlm.

11.3.2 Additional resistance to pyrazinamide

Box 11.3 – Regimen composition for pyrazinamide-resistant Hr-TB

• If linezolid is stopped due to adverse effects before the end of Month 4: replace linezolid with delamanid until the end of treatment.
• If linezolid is contraindicated, use the regimen 6RE-Lfx-Dlm.

11.3.3 Additional resistance to levofloxacin and pyrazinamide

Box 11.4 – Regimen composition for levofloxacin and pyrazinamide-resistant Hr-TB