Table 6– Treatment monitoring: baseline (BL) and follow-up tests during and after treatment of multidrug-resistant/extensively drug-resistant tuberculosis (translated versions of this table can be found in the online supplement)
BL2 weeksTime months
Molecular testing for drug resistanceX
DST from cultureXX+
Renal/liver function testsXXXXXXXXXXXXXXXX
TSH testXX§X§X§X§
Hepatitis B and C serologyX
HIV testX
Pregnancy testX
Visual acuityXX##X##X##X##X##X##X##X##X##X##X##X##X##X##X##
Chest radiographyXXXXXXXX
Thoracic CTX¶¶X¶¶X¶¶
Drug blood levelsX++
  • DST: drug susceptibility testing; TSH: thyroid-stimulating hormone; CT: computed tomography. #: monthly sputum samples should be sent if possible. When sputum cannot be obtained, an induced sputum sample can be attempted. This is especially important at the end of the initial phase (8 months) and at treatment completion to confirm cure. Currently, in many countries, sputa are rarely obtained following culture conversion. Regular sputum sampling throughout the treatment course is highly recommended to identify early treatment failure.: if the QTc is >450 ms, test urine for opiates if drug abuse is suspected and reconsider the use of any drug that may prolong QTc (e.g. moxifloxacin, delamanid, bedaquiline, PA-824, clarithromycin or azithromycin). With bedaquiline, an ECG at weeks 0, 2, 12 and 24 is recommended. In combination treatment with fluoroquinolones, macrolides and clofazimine, even more frequent ECG monitoring might be required. Stop suspected drug if QTc interval is >500 ms. +: DST should be repeated if sputum smear or culture is still positive after 2 months of adequate treatment. §: check thyroid function if the treatment includes ethionamide/prothionamide or p-aminosalicylic acid. ƒ: perform regular audiometry when possible while World Health Organization group II injectable drugs are being used. ##: visual acuity should be regularly evaluated in all patients treated with ethambutol (dose not >15 mg·kg−1) or linezolid (e.g. by Ishihara and Snellen charts). ¶¶: CT may allow better treatment monitoring than chest radiography and should be performed when available. End-of-treatment CT is helpful for comparison if relapse/reinfection is suspected later. ++: monitoring of drug blood levels should be performed when available, especially to avoid drug toxicity of aminoglycosides and to avoid under-dosing with fluoroquinolones. Reference values are presented in table 4.