Standard TB workup recommended. Drug resistance is unlikely but clinical monitoring continues.
Guidelines & Evidence
Clinical Details
Section 1
Major Risk Factors
Prior Treatment History
["Treatment Failure: Sputum positive at month 5 or later of therapy.","Relapse: Sputum positive after being declared cured.","Default: Return after ≥2 months of interrupted therapy."]
Exposure
["Close contact with a known MDR-TB patient.","Healthcare workers in high MDR-prevalence settings.","Incarcerated individuals in regions with high drug resistance."]
Section 2
Diagnostics
Xpert MTB/RIF
The primary tool for rapid detection of MTB and Rifampin resistance. Positive Rif-resistance is a proxy for MDR (H+R resistance).
DST (Drug Susceptibility Testing)
Gold standard. Should be performed for all priority groups (failures, relapses, contacts).
Section 3
Empiric Therapy
Initial Regimen
Do not add a single drug to a failing regimen. If MDR suspected, initiate a standard MDR regimen (including injectable-free options like Bedaquiline) pending DST.
