A UK based resource to support the monitoring and safe use of anti-tuberculosis drugs and second line treatment of multidrug-resistant tuberculosis.
NB: WHO have issued a rapid guidance in August 2018 with substantive changes to all treatment groups in the last 2016 MDR guidance advising that capreomycin and kanamycin should not be used in MDR TB. Amikacin is still within their guidance but this is now downgraded to a group C medication with Bedaquiline now being upgraded to a group A drug. However given that these new guidelines need to be agreed to be implemented locally and nationally, individual cases should still be managed with expert MDR advice and also in conjunction with the BTS MDR Clinical Advice Service review
This guideline is to aid monitoring for adverse effects during the treatment of MDR-TB. It is not a treatment guide or a guide for monitoring the progress of treatment. Advice is based on best available evidence and when this is poor, expert consensus. The monitoring guidelines were developed in the context of the UK where treatment within the NHS is standard and there the tests advised are readily available.
For treatment guidance please refer to the WHO treatment guideline and the BTS MDR-TB Clinical Advisory Service. Treatment of MDR-TB should always be undertaken in consultation with local experts as well as published guidance.
Due to the complexity of treatment regimens and comorbidity associated with the disease itself, more frequent monitoring may be needed in individual patients and this should be guided by the clinician in charge of the patient’s care. Our recommendations are predominantly based on consensus opinion from TB physicians, pharmacists, nursing staff and specialties including audiology and ophthalmology and drug advisory organisations including the FDA and BNF.
We also appreciate that most patients with MDR-TB are established on treatment whilst an in-patient and may require more frequent blood test monitoring during the initial phase of treatment. We have produced this document to provide advice on the frequency of monitoring which should occur, at minimum, in all patients on MDR-TB treatment.
Many side effects cannot easily be measured with routine testing. As such, it is important that all healthcare staff routinely assess patients for symptoms with reference to the potential adverse reactions listed for each drug.
All recommendations below should cover any combination of drugs. Where additional monitoring is required with a specific drug we have noted this and provided a source for further information in the form of individual drug monographs.
Therapeutic drug level monitoring advice is available in individual drug monographs.
British Thoracic Society MDR-TB Clinical Advisory Service (Select MDRTB Service at the bottom of the page)
NOTE new WHO bulletin for TB drug classification 2018
WHO guidance on the treatment of MDR-TB
WHO fact sheet on MDR-TB Short Course
\WHO MDR-TB Short Course FAQs
BTS Clinical Statement MDR-TB Short Course
TB Alert Patient Information Materials
The Truth About TB Community Resources
TB Frequently Asked Questions - British Thoracic Society
Treatment of TB/ HIV Co-infection Guidelines from BHIVA
HIV drug interactions
Hepatitis drug interactions
RESIST-TB Useful Resources