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What is Which of the following is most appropriate treatment of a patient of tuberculosis in which mycobacterium is resistant to both isoniazid and rifampicin? and explain in detail?
Types of resistance in TB: Monodrug Resistance: Resistance against any first line oral drug except Rifampicin (H, Z or E). Polydrug Resistance: Resistance against more than one out of first line oral drugs except Rifampicin. Multidrug Resistance (MDR-TB): Resistance to Isoniazid (H) as well as Rifampicin (R). Rifampicin Resistance (RR): Resistance to Rifampicin but sensitive to Isoniazid. Extensive drug Resistance(XDR-TB): Resistance to H + R + minimum one of the fluoroquinolone (Levoflox, Moxiflox, Gatiflox) + minimum one of the injectable drug (Amikacim, Capreomycin, Kanamycin). Treatment consists of 2 phases: Intensive Phase (IP) and Continuation Phase (CP) Monodrug Resistance IP : 3 months CP: 6 months MDR IP : 6 drugs for 6 months CP: 4 drugs for 18 months XDR IP : 7 drugs for 6 months CP: 6 drugs for 18 months In MDR and XDR TB therapy is decided by Drug sensitivity testing. In the question the case given is of MDR TB.