Management of symptomatic contacts

Clinical description

Household contacts of MDR-TB patients with active PTB Household contacts of MDR-TB patients with active PTB should almost always be treated with MDR-TB regimen. Such patients should be immediately referred to MDR-TB treatment initiating centres for consideration of second-line treatment.

Household contacts of MDR-TB patients with EPTB EPTB is often culture-negative and DST will not be available. These contacts should be started on an MDR-TB regimen based on the DST of the index patient. Every effort should be made to culture aspirates of pleural, peritoneal, or cerebrospinal fluid, depending on the site. Such patients should be referred to MDR-TB treatment initiating centre for further evaluation and consideration of second-line treatment.

122 National Tuberculosis Control Programme Management of drug-resistant TB interrupters Table 10.7-1: Management of drug-resistant TB interrupters Result of last culture prior to interrupting treatment Length of treatment received prior to -OR- Actions interrupting therapy Result of smear and culture upon return to treatment <3 months Positive or negative  Restart original regimen; patient will need full course of treatment.

 Send sputum for culture and DST and adjust regimen to results.

3 months to end of Negative  Continue regimen patient was taking before Intensive phase interruption including the injectable until two cultures return.

 All patients should get a minimum of 20 months of therapy Positive  Restart original regimen; patient will need full course of treatment for 20 months.

 Send sputum for culture and DST and adjust regimen to results.

 If treatment failure was suspected before interruption, consider designing a new regimen.

Continuation Phase N/A  If patient has no evidence of clinical deterioration during interruption, restart continuation phase.

 Send sputum for culture and DST;

o If negative, proceed with continuation phase o If positive, perform second-line DST and review with report and design new DR TB regimen  All patients should get a minimum of 20 months of therapy total.

Note: if the patient interrupted STR for <2 months can restart the same STR, if >2 months should be initiated in individualized regimen