Table 3.
Drug doses and side effects for second-line drugs based on estimated therapeutic efficacy (adapted from WHO recommendations) [21].
| Drug | Dosage | Major Side-Effect |
|---|---|---|
| Levofloxacin | 15–20 mg/kg | QT prolongation, psychiatric disturbance |
| Moxifloxacin | 10–15 mg/kg 10 mg/kg in less than 6 months |
QT prolongation, psychiatric disturbance |
| Bedaquiline | For 100 mg tablet: (100 mg in 10 mL = 10 mg/mL) 0 to <3 months: 3 mL OD for 2 weeks; then 1 mL OD M/W/F for 22 weeks ≥3 to <6 months (3 to <10 kg): 6 mL OD for 2 weeks; then 2 mL OD M/W/F for 22 weeks ≥6 months (10 to <16 kg): 8 mL OD for 2 weeks; then 4 mL OD M/W/F for 22 weeks 16–30 kg: 2 tab OD ×2 weeks then 1 tab OD M/W/F for 22 weeks 30 to <46 kg: 4 tab OD × 2 weeks then 2 tablet OF M/W/F for 22 weeks |
Drug interactions with drugs that inhibit or induce cytochrome P450 enzymes, QT prolongation |
| For 20 mg dispersible tablet: 0 to <3 months: 1.5 OD for 2 weeks; then 0.5 OD M/W/F for 22 weeks ≥3 to <6 months: 3 OD for 2 weeks; then 1 OD M/W/F for 22 weeks ≥6 months (7 to 10 kg): 4 OD for 2 weeks; then 2 OD M/W/F for 22 weeks ≥6 months (10 to <16 kg): 6 OD for 2 weeks; then 3 OD M/W/F for 22 weeks 16–29 kg: 10 OD for 2 weeks then 5 tablet OD M/W/F × 22 weeks. >29 kg: 20 OD × 2 weeks then 10 DTS M/W/F × 22 weeks. | ||
| Linezolid | For 1–15 kg 15 mg/kg OD; For >15 mg/kg 10–12 mg/kg OD |
Bone marrow suppression, peripheral neuropathy, optic neuritis, gastrointestinal disorders |
| Clofazamine | 2–5 mg/kg (give on alternate days if the daily dose is very high) |
Can prolong QT when used with drugs that prolong QT like BDQ, DLM, and fluoroquinolones Orange discoloration of skin, conjunctiva, cornea, and body fluids; dry skin, pruritus, rash, ichthyosis, and xerosis; gastrointestinal intolerance; and photosensitivity Dose adjustment needed in severe hepatic insufficiency |
| Cycloserine | 15–20 mg/kg | Inability to focus, weakness, depression, psychosis and suicidal ideation, seizures, peripheral neuropathy, lichen planus, and Stevens–Johnson syndrome. |
| Ethambutol | 15–25 mg/kg | Ophthalmic, GI disturbance |
| Delamanid | <3 months: 25 mg OD ≥3 months: <16 kg: 25 mg BD; 16 kg to <30 kg: 50 mg morning and 25 mg evening; >30 kg: 50 mg BD 12–17 years:100 mg BD |
Nausea and vomiting, QT prolongation, hallucinations, paraesthesia |
| Pyrazinamide | 30–40 mg/kg | Hepatotoxicity, arthralgia, GI disturbance, dermatological disorder |
| Meropenem | 20–40 mg/kg/IV every 8 hourly (to be used with Clavulanic acid) |
GI disturbances, seizures, hepatic and renal dysfunction |
| Amikacin | 15–20 mg/kg/day (Max 1 g/day) | Nephrotoxicity, ototoxicity |
| Streptomycin | 20–40 mg/kg (Max 1 g/day) | Ototoxicity |
| Ethionamide or prothionamide | 15–20 mg/kg (Max 1 g/day) | Hypothyroidism |
| P-amino salicylic acid | 200–300 mg/kg in 2 divided doses | Hypothyroidism, GI disturbance |
| Isoniazid | 15–20 mg/kg/dose (To be given with pyridoxine) |
Peripheral neuropathy |