Multidrug-resistant Tuberculosis:
An Online Presentation

1. Extensively Drug-resistant (XDR) TB is defined as TB that is resistant to:

	a.	At least six anti-tuberculosis drugs
	b.	At least Isoniazid and Rifampin
	c.	Isoniazid, Rifampin, Ethambutol, Pyrazinamide, Streptomycin, and a fluoroquinolone
	d.	Isoniazid, Rifampin, a fluoroquinolone, and at least one of these three injectable agents (Amikacin, Kanamycin, Capreomycin)

2. Reasonable steps for building a regimen for multidrug-resistant tuberculosis after drug-sensitivities results are known include all of the following EXCEPT:

	a.	Always start by choosing any available first-line drug that the isolate remains susceptible to
	b.	Aim for a total of four to six drugs that the isolate is known to be sensitive to (preferably not drugs used previously by the patient)
	c.	Second-line agents (like Cycloserine, Ethionimide, and PAS) would be preferred over injectable agents to minimize healthcare resources used in association with injections and improve patient comfort
	d.	If there are not four to six drugs available among the first and second-line agents, third-line agents could be considered, preferably in consultation with an expert

3. Clinical management and monitoring plans for the care of MDR/XDR-TB should include (as resources permit) all of the following EXCEPT:

	a.	Daily patient-centered directly-observed therapy (DOT) throughout the entire treatment course
	b.	Diligent recording of drugs given, bacteriological results, chest film findings and any occurrence of medication toxicity
	c.	Periodic sputum specimens for smear and culture, both to document culture conversion and monitor for signs of treatment failure
	d.	Monthly Creatinine, audiogram, and vestibular exam while on fluoroquinolones

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