Nice lecture 👍😊 I need some clarifications plz: 1- on which basis the IP of short MDR- TB regimen shortened to only 4 months or extended to 6 months 2- How & when to monitor MDR-TB treatment with LPA or with culture 3- If Bdq can't be used either not available or contraindicated due to cardiotoxicity what is the alternative option for Long oral regimen ...is it still also SLI or something else? 4- I see Lfx with Bdq and Mfx with SLI Is this combination is a must to avoid drug toxicity 5-U didn't mention the TB regimen in case of Mono/ poly drug resistant TB in patient with Rifampicine sensitive NAAT I hope u enlight me on these issues and thank you Ma'am
Hi Dr Maged ! These are good questions!! 1.The IP of short MDR regimen is at least 4 months , after 4 th month if sputum microscopy is negative then CP shud be initiated else Bdq continued for 2 more months.Also at this time you subject your patient to SL LPA and FL LPA and culture dST to decide IP duration.If new resistance detected, switch to oral longer regimen(evidence for shorter regimen: data from South Africa) 2.Follow up patient monthly in IP and quarterly in CP; culture at end of 3 month,6 month and/or end of T/t. 3. if shorter Oral BDQ cannot be given; shorter injectable regimen can be done: (4/6)Mfxhigh,Km/Am,Eto,Cfz,Z,Hhigh,E/(5)Mfx,Cfz,Z,E 4. FQ used with Bdq potentiate its cardiotoxicity..Evidence exists for both Lfx(or Mfx) with Bdq. But high dose moxiflox is more effective in resistant strains as compd to levoflox and flouroquinolone resistant strains can respond to moxiflox whereas levoflox has better safety profile than moxiflox 5. MOno /poly resistance can be taken in a separate video . Happy Reading !!
Dear Maam if you come across this message please reply 🙏 I am MDR shorter regime patient. During intensive phase my condition was terribly unstable. which let me to skip some medicines. I missed 3 days ethionamide 2 days isonazid 1 day clofazimine 1 day levofloxacin 1000mg pyrazinamide Dear Maam i am still on treatment. I am feeling Frightened😰 now. Will my treatment fail or relapse because of missing those doses?????? I owe you Maam please reply 🙏🙏
Dear Pinky!! Thank you for seeing the video and reaching out . God bless you and keep you stronger … Short interruptions of treatment due to intolerance are common and will not result in relapse / non response so easily. Continue rest of your treatment regularly and i am sure u will be cured completely . Follow up sputum tests are good guide to response and will start turning negative soon 👍🏼👍🏼
Nice explanation In shorter MDR treatment if LPA report is not available during treatment Can we perform LPA test on completion 3 month during treatment
Hello Maam During my intensive phase Doctor gave me only 800mg Ethambutol instead of 1200mg according to my weight and only after 4 months He gave me 1200mg. Will Ethambutol medicine will less work on me now?? 🙄 I'm still on treatment
Madam, I have extra pulmonary MDR patient, Genexpert detected RR from FNAC. I want to know her status on second line drugs susceptibility. Since she is extra pulmonary, can I send her sputum for LPA 2nd line test? Can we still do LPA 2nd line of her genexpert in sputum shows MTB not detected?
Only if she has pulmonary component then sputum sample will help… if its extrapulmonary send the sample from affected site for MGIT, LPA and DST first and second line drugs
Maam,is 4HREZ (IP)+2HRE(CP) FOR NEW TB and PREVIOUSLY TREATED PATIENT? IM VERY CONFUSED in SPM BOOK ITS WRITTEN for PREVIOUSLY treated patient we give 2HREZS+1HREZ (IP) + 5HRE (CP) ...IS IT CORRECT ? WHATS THE DIFFERENCE IN FIRST AND THIS SECOND ONE?? PLEASE MAAM
For all new patients regimen is 2 HRZE and 4 HRE For Previously treated and failures/ defaulters/ recurrent TB it is 2 HRZES+1 HRZE+5 HRE Difference is streptomycin initially, continuation of IP after discontinuing streptomycin for one more month and 5 months of CP
Mam.. I had 18 month of att for my drug sensitive spine tb.. After mri my doctor suggested continuing it for next 6 month along with linozolid for 6 weeks due to residual lesion in spine.. But there is gap of 15 days after 18 months of att treatment as mri process in aiims took this much time..i am afraid.. Will it cause resistance??? Should i take lenozolid.. As it is used in resistance.. I would become resistant to it in future
Please do not self medicate and add any other drug … addition of single drug to any failing / ongoing treatment is discouraged … u may discuss your concern with treating doctor … if resistant TB is considered a repeat culture should be sought , however given the difficulty of sample collection in spine , it is a complex decision
When I seek justification he told me that nothing will happen.. He added that for benefit of doubt.. As all lesion except one small residual one has been resolved
I have started my MDR treatment on 27 sep. Now on 7 sep i got to know that levoflaxacin is resistance. So it means all medicines i have taken with levoflaxacin are resistance now???? please help 😭😭😭😭
Excellent
Very nice presentation it is precise spot on and easy to understand...🎉
thx dear ..plz do short cases long cases for fcps exam ,i m sharing it whatsapp group ,will gain lot of followers
Very nicely explained mam thank you ☺️
Excellent 👌👌 explaination Mam, very helpful BBMP STLS
Nice lecture 👍😊
I need some clarifications plz:
1- on which basis the IP of short MDR- TB regimen shortened to only
4 months or extended to 6 months
2- How & when to monitor MDR-TB treatment with LPA or with culture
3- If Bdq can't be used either not available or contraindicated due to cardiotoxicity what is the alternative option for Long oral regimen ...is it still also SLI or something else?
4- I see Lfx with Bdq and Mfx with SLI
Is this combination is a must to avoid drug toxicity
5-U didn't mention the TB regimen in case of Mono/ poly drug resistant TB in patient with Rifampicine sensitive NAAT
I hope u enlight me on these issues and thank you Ma'am
Hi Dr Maged !
These are good questions!!
1.The IP of short MDR regimen is at least 4 months , after 4 th month if sputum microscopy is negative then CP shud be initiated else Bdq continued for 2 more months.Also at this time you subject your patient to SL LPA and FL LPA and culture dST to decide IP duration.If new resistance detected, switch to oral longer regimen(evidence for shorter regimen: data from South Africa)
2.Follow up patient monthly in IP and quarterly in CP; culture at end of 3 month,6 month and/or end of T/t.
3. if shorter Oral BDQ cannot be given; shorter injectable regimen can be done:
(4/6)Mfxhigh,Km/Am,Eto,Cfz,Z,Hhigh,E/(5)Mfx,Cfz,Z,E
4. FQ used with Bdq potentiate its cardiotoxicity..Evidence exists for both Lfx(or Mfx) with Bdq. But high dose moxiflox is more effective in resistant strains as compd to levoflox and flouroquinolone resistant strains can respond to moxiflox whereas levoflox has better safety profile than moxiflox
5. MOno /poly resistance can be taken in a separate video .
Happy Reading !!
@@pulmonologyreadaloud
Many thanks ma'am 👍
It's very nice explanation Mam..kindly go for rest of the topics of guidelines
Dear Maam if you come across this message please reply 🙏
I am MDR shorter regime patient. During intensive phase my condition was terribly unstable. which let me to skip some medicines. I missed
3 days ethionamide
2 days isonazid
1 day clofazimine
1 day levofloxacin
1000mg pyrazinamide
Dear Maam i am still on treatment. I am feeling Frightened😰 now.
Will my treatment fail or relapse because of missing those doses??????
I owe you Maam please reply 🙏🙏
Dear Pinky!! Thank you for seeing the video and reaching out . God bless you and keep you stronger … Short interruptions of treatment due to intolerance are common and will not result in relapse / non response so easily. Continue rest of your treatment regularly and i am sure u will be cured completely . Follow up sputum tests are good guide to response and will start turning negative soon 👍🏼👍🏼
@@pulmonologyreadaloud
Thank you❤
How r u now
Nice explanation
In shorter MDR treatment if LPA report is not available during treatment
Can we perform LPA test on completion 3 month during treatment
What about resistance in pyrizinamid and ethambutal in shorter MDR treatment and chances to relapse in short and longer treatment
Mam please discuss the latest diagnostic techniques for tb
WHAT IS GENEXPERT/CBNAAT/TRUENAT/LPA- Basics of molecular TB diagnostics - A Refresher !!
ruclips.net/video/B0NupXlqcIQ/видео.html
Mam plz do another part of pmdt and cover the rest😊!
Sure !! Watch the latest shorts video on Regimens for quick revision
Hello Maam During my intensive phase Doctor gave me only 800mg Ethambutol instead of 1200mg according to my weight and only after 4 months He gave me 1200mg.
Will Ethambutol medicine will less work on me now?? 🙄
I'm still on treatment
Madam, I have extra pulmonary MDR patient, Genexpert detected RR from FNAC. I want to know her status on second line drugs susceptibility. Since she is extra pulmonary, can I send her sputum for LPA 2nd line test? Can we still do LPA 2nd line of her genexpert in sputum shows MTB not detected?
Only if she has pulmonary component then sputum sample will help… if its extrapulmonary send the sample from affected site for MGIT, LPA and DST first and second line drugs
Maam,is 4HREZ (IP)+2HRE(CP) FOR NEW TB and PREVIOUSLY TREATED PATIENT?
IM VERY CONFUSED in SPM BOOK ITS WRITTEN for PREVIOUSLY treated patient we give 2HREZS+1HREZ (IP) + 5HRE (CP) ...IS IT CORRECT ? WHATS THE DIFFERENCE IN FIRST AND THIS SECOND ONE?? PLEASE MAAM
For all new patients regimen is 2 HRZE and 4 HRE
For
Previously treated and failures/ defaulters/ recurrent TB it is 2 HRZES+1 HRZE+5 HRE
Difference is streptomycin initially, continuation of IP after discontinuing streptomycin for one more month and 5 months of CP
Maam, Please Tell Drug Sensitive TB treatmen
I will try to post it soon . Thanks
Mam.. I had 18 month of att for my drug sensitive spine tb.. After mri my doctor suggested continuing it for next 6 month along with linozolid for 6 weeks due to residual lesion in spine.. But there is gap of 15 days after 18 months of att treatment as mri process in aiims took this much time..i am afraid.. Will it cause resistance??? Should i take lenozolid.. As it is used in resistance.. I would become resistant to it in future
Please do not self medicate and add any other drug … addition of single drug to any failing / ongoing treatment is discouraged … u may discuss your concern with treating doctor … if resistant TB is considered a repeat culture should be sought , however given the difficulty of sample collection in spine , it is a complex decision
@@pulmonologyreadaloud thanks for reply mam... Doctor himself added that drug..
When I seek justification he told me that nothing will happen.. He added that for benefit of doubt.. As all lesion except one small residual one has been resolved
Kindly guide.. Is it correct??
I have started my MDR treatment on 27 sep. Now on 7 sep i got to know that levoflaxacin is resistance. So it means all medicines i have taken with levoflaxacin are resistance now???? please help 😭😭😭😭
NO it does not imply that other drugs are also resistant. Meet your treating doctor.. the regimen would need modification.All the best
How r u now