Treatment interruptions can lead to the emergence of resistances.
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).
Interruption of the entire treatment for two consecutive months or more meet the definition of "lost to follow-up" (Chapter 17).
Table 9.6 – Management of patients who interrupt treatment
|
Length of treatment before interruption |
Length of interruption |
Management |
|---|---|---|
|
< 1 month |
< 2 weeks |
Continue treatment at the point it was stopped. Doses missed during interruption must be made up to complete the treatment. |
|
2-7 weeks |
Restart treatment or perform RMTs (see below) depending on patient’s clinical evolution. |
|
|
≥ 8 weeks |
Perform RMTs:
|
|
|
≥ 1 month |
< 2 weeks |
Continue treatment at the point it was stopped. Doses missed during interruption must be made up to complete treatment. |
|
≥ 4 weeks |
Perform RMTs:
|
For patients on 6-month regimen who have received adequate treatment for 4 months or more, who return smear negative, are in good clinical condition and with no resistance detected, the decision to restart a treatment is considered on a case-by-case basis.
When a DST is not feasible (e.g. miliary TB, some forms of EPTB, TB in children), clinical and radiological evaluation should guide the decision to either restart DS-TB treatment or change to an DR-TB treatment.