9.6 Management of treatment interruption in patients on first-line regimens
The approach depends on initial bacteriological status, the moment when the patient returns, and the length of previous treatment. The questions of whether or not a patient still presents an active form of the disease, and whether or not he has developed a resistance should always be determined. Treatment interruption can be for any reason.
Every effort should be made to re-start or complete TB treatment in patients who experience treatment interruption.
The approach is, in theory, standardised as described in Table 9.3 and Table 9.4. However, it is often complex and should be based on rigorous study of the patient's history, meticulous clinical examination, and bacteriological examination results. A chest X-ray might be useful, especially if previous ones are available for comparison.
A patient who interrupted his treatment is more at risk of interrupting again. The patient should be followed even more closely and re-motivated with the greatest attention: retreatment regimen may be the last chance of cure, and adapted strategies should be considered to support patient’s adherence (Chapter 13).
9.6.1 New patients on first-line regimens
Table 9.3 - Management of new patients who interrupted treatment
Length of treatment | Length of interruption | Sputum result | Treatment outcome | Classification | Treatment action and registration |
---|---|---|---|---|---|
| < 2 weeks | Not needed | – | – | Continue treatment at the point it was stopped. |
2-7 weeks | Not needed | – | – | Re-start treatment. | |
≥ 8 weeks | Smear+ | Interruption | New | Re-start treatment, perform DSTb. | |
1-2 months | < 2 weeks | Not needed | – | – | Continue treatment at the point it was stopped. |
| Smear+ | – | – | • Re-start treatment, perform DSTb. | |
Smear– | – | – | • Continue treatment at the point it was stopped. | ||
≥ 8 weeks | Smear+ | Interruption | TAIa | Start retreatment, perform DSTb and give a new number to the patient. | |
| < 2 weeks | Not needed | – | – | Continue treatment at the point it was stopped. |
| Smear+ | Cancel previous registration | Others | • Start retreatment, perform DSTb, register as “Others”. | |
Smear– | – | – | • Continue treatment at the point it was stopped. | ||
≥ 8 weeksc | Smear+ | Interruption | TAIa | Start retreatment, perform for DSTb and give the patient a new number. |
a. TAI = Treatment after interruption.
b. Xpert MTB/RIF and conventional DST if available.
c. For patients having received adequate treatment for four months or more who return smear-negative and in good clinical condition, the decision to start a retreatment will be considered on a case by case basis.
9.6.2 Retreatment patients on first-line regimens
Table 9.4 - Management of retreatment patients who interrupted treatment
Length of treatment | Length of interruption | Sputum result | Treatment outcome | Classification | Treatment action and registration |
| < 2 weeks | Not needed | – | – | Continue retreatment at the point it was stopped. |
2-7 weeks | Not needed | – | – | Re-start retreatment. | |
≥ 8 weeks | Smear+ | Interruption Interruption | Same as previous registration | Re-start retreatment and give the patient a new number. | |
| < 2 weeks | Not needed | – | – | Continue retreatment at the point it was stopped. |
| Smear+ | – | – | • Re-start retreatment, ask for DSTb. | |
Smear– | – | – | • Continue retreatment at the point it was stopped, ask for DSTb. | ||
≥ 8 weeks | Smear+ | Interruption Interruption | TAIa | Re-start retreatment, give a new number to the patient, ask for DSTb. |
a. TAI = Treatment after interruption.
b. Xpert MTB/RIF and conventional DST if available.