Figure 1–
a) Evaluation of the Milan extensively drug-resistant tuberculosis epidemic (2013) managed through the European Respiratory Society/World Health Organization Consilium’s expert advice and b) summary of drugs included in the treatment regimen of the index case. Numbers in b) represent date/month. The dosages were as follows. October 4, 2013 (start): ethambutol 400 mg twice daily p.o., pyrazinamide 700 mg twice daily p.o., high-dose isoniazid 400 mg twice daily p.o. and moxifloxacin 550 mg once daily p.o. October 30, 2013 (complete drug susceptibility test available): moxifloxacin 550 mg once daily p.o., amoxicillin-clavulanate (Amox/Clv) 1 g three times per day i.v., terizidone 750 mg once daily p.o., clarithromycin 300 mg twice daily p.o. and linezolid 600 mg twice daily i.v.; linezolid and Amox/Clv were administered i.v. for 6 weeks and then were given orally at the same dosage. November 7, 2013: para-aminosalicylic acid (PAS) 6 g once daily p.o. was added. February 2, 2014: Amox/Clv 1 g three times per day i.v., linezolid 600 mg twice daily i.v., oral moxifloxacin 550 mg once daily p.o., terizidone 750 mg once daily p.o., clarithromycin 300 mg twice daily p.o. and PAS 6 g once daily p.o. February 9, 2014: clofazimine 200 mg once daily p.o. and ethionamide 750 mg once daily p.o. were added, the treatment including linezolid 600 mg twice daily i.v., meropenem 1 g three times per day i.v., amikacin 750 mg OD i.v., Amox/Clv 1 g three times per day i.v., moxifloxacin 550 mg once daily p.o., PAS 550 mg once daily p.o. and high-dose isoniazid 400 mg twice daily p.o. February 19, 2014: all the drugs were stopped due to acute pancreatic insufficiency. March 1, 2014: delamanid 100 mg twice daily p.o. was added with linezolid 300 mg twice daily i.v., meropenem 1 g three times per day i.v. and Amox/Clv 700 g three times per day i.v. March 5, 2014: clofazimine 100 mg once daily p.o. was added to the regimen. March 7, 2014: PAS 8 g once daily p.o. was added to the regimen. March 10, 2014: ethionamide 500 mg once daily p.o. was added to the regimen. PTB: pulmonary tuberculosis; SHREZ+FQ+Inj+Eto: streptomycin, isoniazid, rifampicin and ethambutol, plus fluoroquinolone, all second-line injectables (amikacin, kanamycin and capreomycin) and ethionamide; TST: tuberculin skin test; QF: QuantiFERON; CXR: chest radiography; cat: category; BCG: bacille Calmette–Guérin.