This handout is for drug-resistant tuberculosis (mdr / pre-xdr / xdr). Your care team identified this based on: tb with failed first-line treatment, contact with dr-tb, or dst showing inh + rif resistance (who 2022 module 4).
Other reasons your team may use this plan: xpert mtb/rif positive with rifampicin resistance (who 2022 rapid-diagnostics recommendation); contact with confirmed mdr-tb case (who 2022 contact-investigation guidance); tb meningitis, miliary tb, severe pulmonary tb (ats/idsa/cdc 2022).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| bedaquiline | 400 mg daily × 2 wks then 200 mg three times weekly | PO | daily then 3×/wk | Backbone of BPaL/BPaLM; QT prolonging (WHO 2022; Nix-TB NEJM 2020) |
| pretomanid | 200 mg | PO | daily for 26 wks | Nix-TB (NEJM 2020) / ZeNix (NEJM 2022); pretomanid + bedaquiline + linezolid 6 mo |
| linezolid | 600 mg daily (or 1200 in severe per WHO 2022) | PO | daily | ZeNix (NEJM 2022) — 600 mg × 26 wks balances efficacy + toxicity |
| moxifloxacin | 400 mg | PO | daily | TB-PRACTECAL (NEJM 2022) — added to BPaL as BPaLM for MDR-TB |
| pyridoxine_b6 | 50–100 mg | PO | daily | Reduces neuropathy (WHO 2022) |
Plan: BPaL / BPaLM 6-month short-course MDR/pre-XDR/XDR-TB (IDSA 2024)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
TB clinic monthly; contact tracing; HIV care; nutrition (WHO 2022)
Guideline: WHO 2022 consolidated guidelines on TB treatment (Module 4 drug-resistant)