Adjuvant therapies in drug-resistant TB treatment

Clinical description

The role of adjuvant therapies has not been well established. Nonetheless, some adjunctive modalities have proven beneficial in specific indications (i.e., use of corticosteroids in certain forms of TB such as central nervous system and pericardial involvement), while others show potential to improve outcomes.

• Corticosteroids can be beneficial in conditions like severe central nervous system or

pericardial involvement. Prednisone is commonly used with a tapering of dosage over several weeks.

• Vitamin B6 (pyridoxine) should be given to all DR-TB patients receiving Cycloserine, and

a high dosage of isoniazid or linezolid to prevent neurological adverse drug reactions .

• Vitamin (especially vitamin A) and mineral supplements can be given in areas where a

high proportion of the patients have these deficiencies.

• If multivitamins and minerals are given, they should be dosed three to four hours apart

from the fluoroquinolone, as these can interfere with the absorption of these drugs.

Patient support

• Drug-resistant TB treatment and care should contain integrated nutritional assessment

counselling and support for the duration of the illness.

• Drug-resistant TB can be exacerbated by poor nutritional status.
• Without nutritional support, patients, especially those already suffering from borderline

hunger, can become enmeshed in a vicious cycle of malnutrition and disease.

88 National Tuberculosis Control Programme

• Second-line anti-TB medication can also further decrease appetite, making adequate

nutrition a greater challenge.

• Providing free food probably improves weight gain during treatment and may improve

quality of life.

General consideration for patient support

• NTP procures nutritional supplements and distributes them to district hospitals

quarterly

• District hospitals distribute the nutritional items monthly for patient on MDR-TB

treatment and keep the necessary documentation

• Hospitalised RR-/MDR-TB patients should receive additional nutritional support
• RR-/MDR-TB patients receiving daily injections at treatment centres as outpatients

should be provided with required support, including transportation allowance and accommodation

• Provision of nutritional support can be scheduled along with patient’s monthly follow-

up visit at the registration site.

• District hospital MDR-TB officer-in-charge at should keep records of patients who

received support.