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
at return

Treatment outcome

Classification
at return

Treatment action and registration



< 1 month

< 2 weeks

Not needed

Continue treatment at the point it was stopped.

2-7 weeks

Not needed

Re-start treatment.

≥ 8 weeks

Smear+
Smear–

Interruption

New

Re-start treatment, perform DSTb.



1-2 months

< 2 weeks

Not needed

Continue treatment at the point it was stopped.


2-7 weeks


Smear+

• Re-start treatment, perform DSTb.

Smear–

• Continue treatment at the point it was stopped.

≥ 8 weeks

Smear+
Smear–

Interruption

TAIa
TAIa

Start retreatment, perform DSTb and give a new number to the patient.




≥ 2 months

< 2 weeks

Not needed

Continue treatment at the point it was stopped.


2-7 weeks


Smear+

Cancel previous registration

Others

• Start retreatment, perform DSTb, register as “Others”.

Smear–

• Continue treatment at the point it was stopped.

≥ 8 weeksc

Smear+
Smear–

Interruption

TAIa
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
at return

Treatment outcome

Classification
at return

Treatment action and registration



< 1 month

< 2 weeks

Not needed

Continue retreatment at the point it was stopped.

2-7 weeks

Not needed

Re-start retreatment.

≥ 8 weeks

Smear+
Smear–

Interruption Interruption

Same as previous registration

Re-start retreatment and give the patient a new number.




> 1 month

< 2 weeks

Not needed

Continue retreatment at the point it was stopped.



2-7 weeks

Smear+

• Re-start retreatment, ask for DSTb.

Smear– • Continue retreatment at the point it was stopped, ask for DSTb.

≥ 8 weeks

Smear+
Smear–

Interruption Interruption

TAIa
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.