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The dosage for Drug-resistant TB (DR-TB) drugs used in the regimen by weight bands for adults are enumerated in the table below.

In view of the availability of expertise in medical colleges, there is a felt need to leverage their strength to improve clinical, Adverse Drug Reactions (ADRs) and comorbidity management of patients with Drug-resistant Tuberculosis (DR-TB) across India. 

The following functions and package of services should be offered at each District Drug-resistant Tuberculosis Centre (DDR-TBC):

Figure: Functions of DDR-TBCs

Abbr: NDR-TBC: National Drug-resistant TB Centre; AIC: Airborne Infection Control

Resources

• Guidelines for Programmatic Management of Drug-resistant TB in India, 2021.

The following are requirements from institutions for establishing the district Drug-resistant Tuberculosis Centre (DDR-TBC):

Structural requirements:

To ensure the smooth implementation and regular review of adoption and integration of the national guidelines on airborne infection control in health care and other settings in the states, a State Airborne Infection Control Committee (SAICC) needs to be established at the state level under the umbrella society of the National Health Mission (NHM). 

The table below showcases the composition of this State AIC Committee.

The management of hepatotoxicity during treatment with H mono/poly Drug-resistant TB (DR-TB) regimen is elaborated in the figure below.

Figure: Management of hepatotoxicity during treatment with H mono/poly DR-TB regimen; Source: Guidelines for PMDT, India 2021, p89.

Abbr: AST: Aspartate aminotransferase; ALT: Alanine transaminase; FQ: Fluoroquinolone; R: Rifampin; Z: Pyrazinamide; UNL: Upper Normal Level

The state Airborne Infection Control (AIC) committee meetings should be organized on a quarterly basis with the following functions: 

The state Programmatic Management of Drug-resistant Tuberculosis (PMDT) committee is expected to meet quarterly on the Terms of Reference (ToRs) provided in the figure below.

Figure: Terms of Reference (ToRs) of the State PMDT Committee; Source: Guidelines for PMDT in India, 2021, p204.

Resources

Management of increased QTcF in Electrocardiogram (ECG) entails looking at the algorithm for the reintroduction of anti-TB drugs (Bedaquiline (Bdq)/ Delamanid (Dlm)/ Fluoroquinolone (FQ)/ Clofazimine (Cfz)) once prolonged QTc has normalized, as shown in the below figure.

Figure: Management of prolonged QTcF during treatment with shorter/ longer oral MDR-TB regimen; Source: Guidelines for PMDT, India 2021, p85.

Resources