10.5 Follow-up for patients treated for MDR-TB


Table 10.1 - Routine patient monitoring

Evaluation

Frequency

Assessment by a clinician

During intensive phase: every day during the first weeks if hospitalized and at least every week if treated as outpatient, until the treatment is well tolerated. Once stable, the patient is seen once or twice monthly.

During continuation phase: monthly assessment unless there is a medical necessity to see the patient more often.

The DOT supporter sees the patient daily and signals any concerns to the clinician.

Treatment adherence and tolerance

Daily at every DOT encounters by the DOT supporter.

Sputum smear and cultures

Monthly until the end of treatment.
Note: programmes with very limited culture capacity may consider doing smears monthly but cultures every other month for the continuation phase.

Weight

At baseline and then monthly.

DST

At baseline and for any positive culture during treatment.

Chest X-rays

At baseline and then every three to six months.

Serum creatinine Serum potassium (K+)

At baseline, then twice a month for the first two months, then monthly while receiving an injectable agent. Every one to three weeks in HIV-infected patients, diabetics throughout the course of the injectable agent.

Thyroid stimulating hormone (TSH)

Every six months if receiving Eto/Pto and/or PAS (every three months in HIV positive patients) and whenever signs/symptoms of hypothyroidism are present. TSH is sufficient for screening for hypothyroidism and it is not necessary to measure hormone thyroid levels.

Liver serum enzymes

At baseline then monthly during the intensive phase. Every 3 months thereafter. Monthly monitoring for HIV-infected.
In patients with viral hepatitis: once weekly for the first month, then every one to four weeks.
Monthly for patients taking Bdq.

Bilirubine

Monthly for patients taking Bdq.

HIV screening

At baseline then repeat when clinically indicated or every 6 months in high HIV prevalence settings.

Pregnancy tests

At baseline for women of childbearing age, and repeat if indicated.

Haemoglobin White blood count

If on Lzd, weekly during the first month, then monthly or as needed based on symptoms; there is little clinical experience with prolonged use of Lzd.
For HIV-infected patients on AZT: monthly initially and then as needed based on symptoms.
If patient not on Lzd or AZT, routine monitoring is not indicated.

Hearing tests

Baseline audiogram, then monthly during intensive phase (and whenever clinically indicated). Ask patient about changes in hearing at every clinic visit and evaluate their ability to participate in normal conversation.

Vision tests

For patients on long-term E or Lzd, use the Ishihara test (test for changes in the vision of colour). Perform at baseline as a certain percentage of the population has colour blindness. Then monthly in patients taking Lzd.

Psycho-social consultation

At baseline by trained personnel in the skills of psycho-social management, during treatment and repeat as indicated. Refer to psychiatrist when indicated.

ECG

Patients taking Bdq: at baseline then, after 2 weeks then, monthly.