Treatment will be gradually expanded to the two regional referral hospitals 

National referral hospital in Thimphu will implement the shorter regimen of multi-drug-resistant tuberculosis (MDR-TB) treatment with enrollment of 15 MDR-TB patients from April.

As per the updated Drug-Resistant TB guideline, which was launched during the World TB Day on March 24, the 15 patients fulfil the criteria for the treatment.

Deputy chief programme officer with the National Tuberculosis Control Programme, Chewang Rinzin, said the drugs have already been procured for the patients and supplied to the national referral hospital.

With this shorter regimen, duration of MDR-TB treatment will be shortened from 20 months to 11 months.

Chewang Rinzin said the intensive phase treatment  is for four to six months and continuation phase treatment for five months.

“The continuation phase treatment is four to six months because if the patient fails to convert sputum at four months, it can be extended for another two months,” he said. “The continuation phase treatment is  recommended not to be prolonged and should not be more than five months.”

Chewang Rinzin said that shorter regimen treatment is recommended for patients with rifampicin-resistant TB or MDR-TB, who have not been previously treated with second-line drugs and for whom resistance to fluoroquinolones and second-line injectable agents has been excluded or is considered highly unlikely.

Fluoroquinolones are antibiotics that are commonly used to treat a variety of illnesses. The second-line drugs for the treatment of tuberculosis are reserved for the treatment in a special situation such as MDR-TB, extensively drug-resistant tuberculosis, or resistance to first-line therapy.

“Shorter regimen is recommended to children, adults and HIV patients with MDR-TB who has been diagnosed on laboratory confirmation fulfilling the above criteria,” Chewang Rinzin said. “Ideally, patients are tested for resistance to fluoroquinolones and second-line injectable drugs.”

He added that all MDR-TB patients are not eligible for the shorter regimen. “Shorter regimen is not recommended if the MDR-TB patient is resistance to second-line drugs of shorter regimen except isoniazid (antibiotic) resistance.”

The treatment is also not recommended for MDR-TB patients who are exposed to one or more than one second-line medicines in the shorter MDR-TB regimen for more than one month if they cannot tolerate to more than one medicine in the shorter MDR-TB regimen. Also, it not recommended during pregnancy and for patients with Extra-Pulmonary TB.

Shorter treatment regimen has seven different drugs during the intensive phase treatment and four during continuation phase treatment. For the longer treatment regimen, there are five different drugs during intensive phase treatment and four drugs during continuation phase treatment.

Anti-TB medicines have side effects and the patients need to be closely monitored, Chewang Rinzin said.

Chewang Rinzin said it was not advisable to shorten the duration of intensive or continuation phase for the shorter regimen of MDR-TB treatment or prolong them if lack of response is observed.

The hospitals will continue administering longer regimen treatment to MDR-TB patients who are not eligible for the shorter regimen.

“Shorter regimen reduces length of treatment and it is tolerable, effective and less expensive treatment per patient with better outcome,” Chewang Rinzin said.

Dechen Tshomo