Active Ingredients: Azithromycin
Practice guidelines that serve to complement the current statement have been developed by the IDSA 3.
. Testing of visual acuity and red-green color discrimination should be obtained when EMB is to be used.
Criner. For patients with relapse who did not receive DOT, who were not treated with a rifamycin-based regimen, or who are known or presumed to have had irregular treatment, it is prudent to infer that drug resistance is present and to begin an expanded regimen with INH, RIF, and PZA plus an additional two or three agents based on the probability of in vitro susceptibility.Persons using assistive technology might not be able to fully access information in this file.
Usual agents to be employed would include a fluoroquinolone levofloxacin, moxifloxacin, or gatifloxacin, an injectable agent such as SM if not used previously and susceptibility to SM had been established, amikacin, kanamycin, or capreomycin, with or without an additional oral drug.
Treatment failure is defined as continued or recurrently positive cultures during the course of antituberculosis therapy.
Thus, patients with positive cultures after 3 months of what should be effective treatment must be evaluated carefully to identify the cause of the delayed conversion.
Patients whose sputum cultures remain positive after 4 months of treatment should be deemed treatment failures. Possible reasons for treatment failure in patients receiving appropriate regimens include nonadherence to the drug regimen the most common reason, drug resistance, malabsorption of drugs, laboratory error, and extreme biological variation in response.
If treatment failure occurs, early consultation with a specialty center is strongly advised.
If the patient is seriously ill or sputum AFB smears are positive, an empirical regimen should be started immediately and continued until susceptibility tests are available.
For patients who have treatment failure. A fundamental principle in managing patients with treatment failure is never to add a single drug to a failing regimen; so doing leads to acquired resistance to the new drug. Instead, at least two, and preferably three, new drugs to which susceptibility could logically be inferred should be added to lessen the probability of further acquired resistance.
Empirical retreatment regimens might include a fluoroquinolone, an injectable agent such as SM if not used previously and the patient is not from an area of the world having high rates of SM resistance, amikacin, kanamycin, or capreomycin, and an additional oral agent such as p-aminosalicylic acid PAS, cycloserine, or ethionamide.
Once drug-susceptibility test results are available, the regimen should be adjusted according to the results. Patients having tuberculosis caused by strains of M.
Such patients should be referred to or consultation obtained from specialized treatment centers as identified by the local or state health departments or CDC.
Although patients with strains resistant to RIF alone have a better prognosis than patients with MDR strains, they are also at increased risk for treatment failure and additional resistance and should be managed in consultation with an expert.