Tuberculosis Consultant Services

In increasing number of countries adapted to switch directly to the most efficacious 6-month regimen containing rifampicin throughout as their first-line regimen. This is and was understandable under the ethical imperative that any patient should receive the most efficacious known regimen.

However, the approach has a serious drawback as it destroys the concept of a cascade of regimens unless the fall-back regimen was designed to cure multidrug-resistant tuberculosis.

It is apparent that patients failing on a rifampicin containing continuation phase in the first-line regimen cannot be cured with the standard retreatment regimen: the only effect is the potential to also acquire ethambutol resistance.

Countries not disposing of second-line drugs and an infrastructure to deliver them would thus have to put a fallback regimen for the treatment of multidrug-resistant tuberculosis at the disposal of all patients requiring it because of a bacteriological failure to the first line regimen.