Chart 5. Treatment of monodrug-resistant and polydrug-resistant tuberculosis.
| Resistance to | Regimena | |
|---|---|---|
| Intensive phase | Maintenance phase | |
| H | 2RZES | 4RE( 10 ) |
| R | 6S3HZELfx | 6HELfx( 30 ) |
| R (identified by rapid molecular testing)b | 8Cm3EZLfxTrd | 10ELfxTrd |
| H + Zc | 2RESO | 7REO |
| H + Ec | 2RZSO | 7RO |
| R + Z | 8HCm3EZLfxTrd | 10HELfxTrd( 30 ) |
| R + E | 8Cm3EtZLfxTrd | 10HEtLfxTrd( 30 ) |
| H + Z + E | 3RSOTd | 12ROT( 10 ) |
H: isoniazid; R: rifampin; Z: pyrazinamide; E: ethambutol; S: streptomycin; Lfx: levofloxacin; Cm: capreomycin; Trd: terizidone; O: ofloxacin; and Et: ethionamide. aThe number preceding the acronym indicates duration of treatment in weeks. The subscript number after a drug abbreviation indicates the number of days per week that the drug should be used; if there is no subscript number, treatment with that drug is daily. bIf there is monoresistance to R and the patient has been on the 8Cm3EZLfxTrd/10ELfxTrd regimen for more than 1 month, continue the regimen until completion; if the patient has been on that regimen for less than 1 month, discontinue it and start the 6S3HZELfx/6HELfx regimen. If susceptibility testing shows multidrug resistance (R + H or R + H + resistance to any other first-line drugs), see Chart 3. If susceptibility testing shows polyresistance (R + resistance to first-line drugs other than H), continue the regimen for R-resistant tuberculosis with the addition of H: 8HCm3EZLfxTrd/10 HLfxTrd (Chart 4). 30 ) cOptionally replace O with Lfx. 10 ) dExtend the intensive phase for 6 months in cases of extensive bilateral disease. 10