A UK based resource to support the monitoring and safe use of anti-tuberculosis drugs and second line treatment of multidrug-resistant tuberculosis.
NB: The WHO consolidated guidelines on drug-resistant tuberculosis treatment 2019, advise that 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, whilst delamanid remains a group C drug.
Bedaquiline and delamanid may be prescribed in England in line with the NHS England Clinical Commissioning.
Policy Statement: Treatment for defined patients with MDR-TB and XDR-TB including bedaquiline and delamanid
We recommend that 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.
Patient Information Leaflet A leaflet is available to download at https://www.thetruthabouttb.org/professionals/patient-support/ and is available in English and Albanian, Bengali, Chinese (simplified), Farsi, French, Greek, Gujarati, Italian, Pashto, Polish, Portuguese, Punjabi, Romanian, Somali, Sorani, Spanish, Tamil, Turkish, Urdu and Vietnamese.
British Thoracic Society MDR-TB Clinical Advisory Service (Select MDRTB Service at the bottom of the page)
WHO Consolidated Guidelines on Tuberculosis, Module 4: Treatment - Drug-Resistant Tuberculosis Treatment
BTS Clinical Statement MDR-TB Short Course
TB Alert Patient Information Materials
Treatment of TB/ HIV Co-infection Guidelines from BHIVA
HIV drug interactions
Hepatitis drug interactions
RESIST-TB Useful Resources
Sentinel Project on paediatric drug-resistant tuberculosis