DR TB Treatment Guideline of Timor Leste

Definitions of drug resistance (1)

• Mono-resistance: resistance to one anti-tuberculosis drug.
• Poly-resistance: resistance to more than one anti-tuberculosis
drug, other than both isoniazid and rifampicin.
• Multidrug-resistance (MDR-TB): resistance to at least isoniazid
and rifampicin.
• Rifampicin-resistant TB (RR-TB): resistance to rifampicin
detected using phenotypic or genotypic methods, with or
without resistance to other anti-TB drugs.
 Definitions of drug resistance (2)
• Extensively drug-resistant TB (XDR-TB): resistance to any
fluoroquinolones (FQs) and to the second-line injectables (SLIs)
(amikacin, streptomycin), in addition to multidrug resistance
• Pre-extensively drug-resistant TB (pre-XDR-TB): resistance to
any FQ or to at least one of the three SLIs (amikacin,
capreomycin and kanamycin), in addition to multidrug
resistance.19
Grouping of Medicines recommended for the treatment of
RR-TB and MDR-TB according to WHO
Rapid Communication
WHO 2019
MDR/RR-TB patients who:
• Have no previous exposure to
second-line treatment (including
bedaquiline)
• Have no fluoroquinolone
resistance
• No extensive TB disease or
severe extrapulmonary TB
The preferred treatment option is a
shorter, all-oral, bedaquiline-
containing regimen
 All oral shorter-treatment regimen for Timor Leste

2 Lzd - 6 BDQ - Lfx - Cfz - Z - E / 5 Lfx-Cfz-Z-E

Intensive Phase Continuation Phase

intensive Phase Continuation Phase
(Given everyday for 6 months) (Given everyday for 5 months)

1. Linezolid (Lzd) for 2 months 1. Levofloxacin (Lfx)

2. Bedaquiline (Bdq) 2. Clofazimin (Cfz)
3. Levofloxacin (Lfx) 3. Pirazinamid (Z)
4. Clofazimin (Cfz) 4. Etambutol (E)
5. Pirazinamid (Z)  
6. Etambutol (E)
 When to use longer regimen?
MDR/RR-TB patients with:
• Extensive TB disease
• severe forms of extrapulmonary TB
• Resistance to FQ or who have been exposed to treatment with
2nd line drugs
will benefit from an individualized all oral longer regimen
 All oral longer regimen for Timor Leste

6 Lfx - Bdq - Lzd - Cfz - Z / 12 Lfx – Cs – Cfz

Intensive Phase Continuation Phase

intensive Phase Continuation Phase
(Given everyday for 6 months) (Given everyday for 12 months)

1. Levofloxacin (Lfx) 1. Levofloxacin (Lfx)

2. Bedaquiline (Bdq) 2. Cycloserine (Cs)
3. Linezolid (Lzd) 3. Clofazimin (Cfz)
4. Clofazimin (Cfz)
5. Pirazinamid (Z)  
 All oral longer regimen for Timor Leste
• The following principles for the determination of treatment duration
apply:

– A total minimum duration of 18 months depending on patient’s response

– A treatment duration of 16 months is recommended after culture conversion
– The treatment duration may be modified as per patient’s response to
treatment
– Prolonging the treatment longer than 20 months may be considered in
patients with additional resistance or late converters, extensive disease and
other risk factors for failure or relapse of treatment.
Choosing between shorter and longer all-oral regimen
Follow-up examinations during DR-TB treatment
 It’s

TIME
For simple and shorten TB
Treatment
Thank You New TB drug regimens  awaiting
promising results to a shorter, safer, and
more effective solution.

Towards TB Elimination