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Renal insufficiency due to longstanding TB disease itself, previous use of aminoglycosides or concurrent renal disease is not uncommon and great care should be taken in the administration of second-line drugs in such patients. ​

Drugs that might require a dose or interval adjustment when there is mild to moderate renal impairment are Ethambutol (E) and Levofloxacin (Lfx).​ In cases with severe renal impairment, Lfx can be replaced with a normal dose of Moxifloxacin (Mfx) (200/400 mg/kg).​ 

Laboratory systems and diagnosis pose several challenges in streamlining and upscaling as follows:

Workers in microbiological laboratories are not only exposed to pathogenic microorganisms, but also to chemical hazards. Therefore, knowledge of the toxic effects of these chemicals, exposure routes and hazards, that may be associated with handling and storage, is important.

A few important general safety measures against chemical exposure in laboratories are:

Liquid Culture (LC) and Line Probe Assay (LPA) specimen processing involves pre-treatment of the sputum specimens.

Digestion and decontamination are usually done using N-acetyl-l-cysteine–sodium hydroxide (NALC- NaOH) method: 

• The process is essential to free TB bacilli from the mucus cells/ tissue.
• This also helps in decontamination by killing normal flora that grows more rapidly than the TB bacilli. 

NALC-NaOH Method for Sample Processing
 

Biomedical Waste Management is an essential biosafety component of TB containment laboratories. All infectious materials should be decontaminated, incinerated, buried or autoclaved.

The following materials are suitable for waste disposal by autoclaving:

• All positive TB cultures 
• Mycobacterial cultures 
• All infectious materials from TB-containment laboratories where mycobacterial culture is performed