What specific drugs are included in the 22-month treatment regimen for pre-XDR MDR TB?

The 22-month treatment regimen for pre-extensively drug-resistant multidrug-resistant tuberculosis (pre-XDR MDR TB) typically includes a combination of several key drugs. These regimens are designed to address the complexity and severity of the disease, ensuring a comprehensive and effective treatment approach. The specific drugs included in the 22-month regimen are:
  1. Bedaquiline (Bdq): An essential component in the treatment of drug-resistant TB, bedaquiline is often included in longer regimens due to its effectiveness against resistant strains.
  2. Delamanid (Dlm): Another crucial drug, delamanid is used in combination with other agents to enhance the efficacy of the treatment.
  3. Linezolid (Lzd): Known for its strong bactericidal activity, linezolid is a key drug in the treatment of pre-XDR MDR TB.
Preview
  1. Clofazimine (Cfz): This drug is often included in regimens for its additional antimicrobial properties and its role in preventing relapse.
  2. Levofloxacin (Lfx) or Moxifloxacin (Mfx): These fluoroquinolones are critical in treating TB that is resistant to first-line drugs.
  3. Pyrazinamide (Pza): Often used in combination with other drugs to shorten the duration of treatment and improve outcomes.
  4. Ethambutol (Emb): Another first-line drug that is sometimes included in longer regimens to ensure comprehensive coverage against TB bacteria.
  5. Isoniazid (InhH): High-dose isoniazid may be used in certain regimens to enhance the treatment's effectiveness.
  6. Cycloserine/Terizidone: These drugs are sometimes included as part of the Group B agents to provide additional antimicrobial coverage.
  7. Injectable Agents: In some cases, injectable drugs such as amikacin, capreomycin, or kanamycin may be included, although this is less common in newer regimens that aim to avoid injectables due to their side effects.
Preview
These drugs are combined in various ways to create a regimen that is tailored to the specific drug resistance profile of the patient and the severity of their disease. The 22-month duration is often necessary to ensure that all bacteria are eradicated and to prevent relapse, especially in cases of severe TB disease at the start of treatment.