TB DRUG MONOGRAPHS
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A UK based resource to support the monitoring and safe use of anti-tuberculosis drugs and second line treatment of multidrug-resistant tuberculosis.

Please see the latest WHO guidance for regimen choice in MDR-TB.

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
INTRODUCTION
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
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.
FULL GUIDANCE: PDF Last updated JANUARY 2024
mdrtb_adr_monitoring_guidance_january_2024.pdf
File Size: 1367 kb
File Type: pdf
Download File

USEFUL LINKS
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 2022 Update
​
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
FEEDBACK
[email protected]
The information we have provided here is not exhaustive and is aimed as a practical tool for aid in the management of patients with MDR-TB.  A list of references is included in a separate document however the majority of these recommendations are based on expert consensus.   Feedback is welcomed.  This is a drug monitoring guideline, for treatment guidance please refer to the WHO Consolidated Guidelines on Tuberculosis, Module 4: Treatment - Drug-Resistant Tuberculosis Treatment https://www.who.int/publications/i/item/9789240007048  and the BTS MDR-TB Clinical Advisory Service www.brit-thoracic.org.uk/quality-improvement/lung-disease-registries/bts-mdr-tb-clinical-advice-service/