TB III

Question 1

What is the new regimen for drug-resistant TB?

Answer 1

BPaL-L:
* At least 3 drugs used for 6 months

Question 2

What is the long regimen for Drug resistant TB?

Answer 2

18 months

Question 3

What are the indications for the long TB regimen?

Answer 3

Complicated EPTB / extensive
disease on CXR
* Children < 6 years
nd
* Hxof previous treatment with 2
line drugs for more than 1 month
* Contact with XDR / Pre-XDR
* Both INH mutations

Question 4

What is the 6 months BPaL-L regimen?

Answer 4

Bedaquiline,
* Pretomanid,
* Linezolid (600 mg)
* With or without levofloxacin (if sensitive)

Question 5

What are the 5 core drugs for long course TB treatment?

Answer 5

Bedaquiline
Linezolid
Levofloxacin (substitute if flouroquinolone resistance)
Clofazimine
Terizidone

Question 6

What is a side effect of terizidone? How is it prevented

Answer 6

It causes peripheral neuropathy
Prevented by co-administration with pyridoxine (50mg for adults, 25mg to children)

Question 7

Long course drug-resistant TB treatment for children >/= 6 years old

Answer 7

Bedaquiline ≥6 years is safe for use

Question 8

In children between 3-6 years, which drug can be substituted for bedaquiline in the long course TB treatment?

Answer 8

Delamanid

Question 9

For children under 3 years old, which drug can be used to substitute for bedaquiline?

Answer 9

Para-aminobenzoic acid

Question 11

MOA of bedaquiline

Answer 11

Inhibits mycobacterial ATP synthase

Question 12

Metabolism of Bedaquiline?

Answer 12

PKs: metabolised by CYP3A4 need LFT monitoring (ALT, AST, bili)

Question 13

Bedaquiline interacts with which group of drugs?

Answer 13

CYP3A4 inhibitors / inducers, hepatotoxic drugs

fluoroquinolones, macrolides, clofazimine, diseases

Question 14

What are the major adverse effects of bedaquiline?

Answer 14

QT prolongation (ECG monitoring – stop if
>500ms)

Question 15

MOA and distribution of Terizidone

Answer 15

MOA: Inhibits peptidoglycan synthesis
* Widely distributed including CSF

Question 16

Major adverse effects of Terizidone

Answer 16

Peripheral neuropathy (treat with pyridoxine or amitriptyline)

Seizures, anxiety, depression, psychosis

Question 17

Drug interaction with Terizidone

Answer 17

Isoniazid

Question 18

Contra-indications of Terizidone

Answer 18

CI: psychiatric disorders/symptoms

Question 19

Explain the pharmacokinetics of Clofazimine

Answer 19

Accumulate in tissues: fat, skin, liver, kidneys and reticulo-endothelial cells – cause
red-brown pigmentation of conjunctiva and skin; may impart red colour to urine,
sweat, tears, sputum

Question 20

Where is clofazimine eliminated?

Answer 20

In bile and faeces

Question 21

What should you monitor when a patient is taking Clofazimine?

Answer 21

Monitor hepatic function

Question 22

What should you counsel a patient on when using Clofazimine?

Answer 22

Take with food to diminish GI upset

Question 23

In children taking Delamanid, what should you monitor?

Answer 23

monitor for neuropsychiatric adverse effects:
insomnia, hallucinations, night terrors

Question 24

What are common Adverse effects of Delamanid?

Answer 24

Common, nausea, vomiting and dizziness
* QT prolongation (discontinue if QTcF is >500ms or ventricular
arrhythmia)
* DI: fluoroquinolones, macrolides, bedaquiline, clofazimine

Question 25

Drug interactions of Delamanid?

Answer 25

hepatotoxic drugs & CYP3A4 inhibitors

Question 26

What is a counselling point when taking Delamanid?

Answer 26

Counselling: take with food to diminish GI upset

Question 27

MOA of Pretomanid

Answer 27

inhibit bacterial cell wall mycolic acid biosynthesis

Question 28

Pretomanid is administered with (1)_________ and (2)____________to treat resistant forms
of pulmonary TB

Answer 28

1. Bedaquiline
   2.Linezolid

Question 29

List major adverse effects of Pretomanid

Answer 29

Peripheral neuropathy, acne, anaemia

Question 30

Drug interactions of Pretomanid

Answer 30

Avoid alcohol and hepatotoxic agents, strong or moderate CYP3A4 inducers, including herbal supplements