3
Summary of Good Practices
➤ For patients being evaluated and treated for any form of drug-
resistant TB, the following 6 ungraded good practice statements are
emphasized since the writing committee had high confidence in their
net benefit:
1. Consultation should be requested with a TB expert when there
is suspicion of or confirmation of DR-TB. In the United States ,
TB experts can be found through CDC-supported TB Centers of
Excellence for Training, Education, and Medical Consultation
(http://www.cdc.gov/tb/education/rtmc/default.htm), through
local health department TB control programs (https://www.cdc.
gov/tb/links/tboffices.htm), and through international MDR-TB
expert groups such as the Global TB Network.
2. Molecular DSTs should be obtained for rapid detection of
mutations associated with resistance. When rifampin resistance
is detected, additional DST should be performed immediately
for first-line drugs, fluoroquinolones, and aminoglycosides.
Resistance to fluoroquinolones should be excluded whenever
isoniazid resistance is found.
3. Regimens should include only drugs to which the patient's
M. tuberculosis isolate has documented or high likelihood of
susceptibility (hereafter defined as effective). Drugs known to
be ineffective based on in vitro growth to based or molecular
resistance should NOT be used. This recommendation applies
to all drugs and treatment regimens discussed in this practice
guideline, unless reliable methods of testing susceptibility for a
drug have yet to be developed.
4. Treatment response should be monitored clinically,
radiographically and bacteriologically, with cultures obtained at
least monthly for pulmonary TB. When cultures remain positive
after three months of treatment, susceptibility tests for drugs
should be repeated. Weight and other measures of clinical
response should be recorded monthly.
5. Patients should be educated and asked about adverse effects at
each visit. Adverse effects should be investigated and ameliorated.
6. Patient-centered case management helps patients understand
their diagnoses, understand and participate in their treatment,
and discuss potential barriers to treatment. Patient-centered
strategies and interventions should be used to minimize barriers
to treatment.
