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Q. How to treat multidrug-resistant tuberculosis?

Answered by
Dr. Amolkumar W. Diwan
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Oct 07, 2015 and last reviewed on: Feb 01, 2019

Hello doctor,

I have been diagnosed with multidrug-resistant tuberculosis. I have attached the reports. Please suggest a way to treat this.

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Hello,

Welcome to icliniq.com.

I have seen both the reports (attachment removed to protect patient identity). Sputum report is positive and has also grown Mycobacterium tuberculosis. But the sensitivity test for all five first-line drugs is not done. Patient weight is also not mentioned.

If it is MDR-TB (Multi-drug-resistant tuberculosis), thesecond-line drugs should be started with remaining sensitive first-line drugs. When there is no report of resistance to Isoniazid or Rifampicin, only then we say it as MDR-TB. So, please get done the sensitivity test for all first and second line drugs from the same lab.

The patient must take injection Streptomycin 750 mg IM (intramuscular) daily along with tablet Akurit 4 (combination of Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol) according to weight. Also, give protein supplements like eggs and proteinex powder with milk.


The Probable causes:

Decreased immunity might be a cause.

Investigations to be done:

Sputum AFB culture.
Sensitivity test for first and second line drugs.

Differential diagnosis:

Multi-drug-resistant tuberculosis (MDR-TB)

Treatment plan:

Second line anti-tubercular treatment.

Preventive measures:

Compulsory use of mask by the patient.


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