Guidelines for Second Line Anti-Tuberculous Treatment in Pakistan

Nisar Ahmed Rao


The emergence of resistant strains of Mycobacterium Tuberculosis is becoming a continous challenge for Physicians and has made it necessary to be more vigilant and concerned about second line anti tuberculous drugs. Patients retreated with 5 drugs regimen in the initial phase for 3 months and then 2 months as a continuation phase wiht the first line anti tuberculous drugs, still remianing AFB smear positive, cna be labelled as resistant tuberculosis. The overall incidence of resistant tuberculosis is increaisng by variable numbers in different countries.

In Pakistan the resons for multi drug resistant strains are mainly poverty, malnutrition, inappropriate combination and dosage fo anti tuberculous drugs lack of patients compliance and infectio wiht initial drug resistant mycobacteria. drugs used as second line treatment are Kanamycin, ethionamide, Prothionamide, Cycloserin adn Capreomycin. Drugs like ciprofloxacin, ofloxacin, clofamazin and calrithromycin are under trial and still needs justification for their regular use. While recommending second line treatment always 3-4 new effective drugs should be added to prevent resistance, starting with 3-4 months of intensive phase and then a continuation phase, to complete 24 months. Cost of the second lime treatmetn makes a lot of difference to poor patients as it is quite costier than the first line durgs. Proper follow up of patients on second line drugs, and hospitalization for the whole intensive phase to ensure a fully supervised treatment is necessary. Switching over to continuation phase depends on conversion of the sputum smear ro negative at least by the end of 6 months of intensive phase treatment. it will be of no use to continue ATT if the sputum smears are positive for AFB by the end of 6 months intensive phase therapy, all that is needed for such patients will be a Psychiatric help and awarness of the family.


Resistant Pulmonary Tuberculosis; Second line treatment

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