Drug-resistant tuberculosis treatment

Patients on the shorter MDR-TB regimen have a much shorter duration of intensive phase and 
total treatment. They receive seven drugs in the initial phase and, if fully compliant with the inclusion/ 
exclusion criteria, usually have a more favourable prognostic outlook than other MDR-TB patients. 
Programmes may thus consider that patients on a shorter MDR-TB regimen may need less frequent 
or no culture to monitor treatment. While the current analysis did not include patients treated with 
shorter regimens, the GDG proposes that programmes that implement this regimen aim for more 
frequent culture testing, especially after the intensive phase, to confirm bacteriological cure in patients 
who complete treatment without signs of failure. Any sign of recurrence after termination of treatment 
should also be investigated using sputum smear microscopy, culture and
DST.
5.4 Implementation considerations
Good-quality sputum specimens are necessary to ensure that laboratories can diagnose TB properly. 
In addition, laboratories should have sufficient space to ensure the quality, safety and efficiency of the 
services provided to clients whose samples are tested, and to ensure the safety of laboratory personnel, 
patients and visitors (97). Some countries experience difficulties with the implementation and quality 
assurance of sputum culture, which impacts upon this recommendation as it is dependent on access 
to quality-assured laboratories that can offer TB culture. Sputum smear and culture examinations are 
also dependent on the quality of the sputum produced, so care should be taken to obtain adequate 
specimens and transport them to the laboratory according to standard procedures to maintain the 
viability of the bacilli to get a valid culture
result.
In programmatic settings, the practitioner treating MDR-TB patients is typically guided not only by 
bacteriological tests but also by markers of response to treatment or of disease progression, such as 
the patient’s general condition, weight gain over time, resolution of disease manifestations, blood 
indices and results of imaging (e.g. chest radiography). The potential use of Xpert MTB/RIF assay in 
monitoring treatment response has yet to be determined (98, 99).
The implementation of more frequent culture testing would require appropriate resources to be made 
available, both for the laboratories undertaking the tests as well as the patient who may have to spend 
more time visiting the facilities and, at times, pay for the testing. Patient values and preferences need 
to be considered to ensure a more acceptable service and patient-centred delivery of care. Increased 
monitoring should not be done at the expense of overburdening the laboratory services or upsetting 
health equity by displacing resources from other essential components of the
programme.