When dealing with second-line anti-tuberculosis, medications used after first‑line drugs fail or when the bacteria are resistant. Also known as second‑line TB therapy, it plays a crucial role in managing resistant forms of tuberculosis.
Resistance doesn’t happen in a vacuum. multi‑drug resistant tuberculosis (MDR‑TB), a strain resistant to at least isoniazid and rifampicin pushes clinicians toward second-line options. Another jump is extensively drug‑resistant tuberculosis (XDR‑TB), which adds resistance to fluoroquinolones and at least one second‑line injectable. Both conditions demand a stronger drug arsenal and careful monitoring.
Typical second-line drugs include fluoroquinolones like levofloxacin, injectable agents such as amikacin, and oral agents like cycloserine. Each class brings its own profile: fluoroquinolones target bacterial DNA replication, injectables disrupt protein synthesis, and cycloserine interferes with cell wall formation. Choosing the right mix depends on drug susceptibility testing, lab results that show which drugs the TB strain can still fight. The test result directly influences the design of a personalized treatment regimen.
Effective management of resistant TB also means watching for side effects. Injectable agents can cause hearing loss, while fluoroquinolones may trigger tendon issues. Monitoring liver function, kidney health, and auditory capacity becomes part of the daily routine. Patients often need nutritional support and mental‑health counseling because the treatment lasts 18‑24 months and can be exhausting.
Even with the best drugs, adherence is the linchpin of success. Directly observed therapy (DOT) is a proven strategy: a health worker watches the patient take each dose, reducing missed pills and preventing further resistance. Combining DOT with mobile reminders and patient education boosts completion rates, especially in remote areas.
Research continues to expand the second-line arsenal. New drugs like bedaquiline and delamanid have shown promise against XDR‑TB, offering oral alternatives to painful injectables. Clinical trials are also exploring shorter regimens that could cut treatment time in half, which would improve adherence and lower costs.
Below you’ll find a curated list of articles that dive deeper into each of these topics—drug choices, side‑effect management, testing protocols, and emerging therapies. Whether you’re a healthcare professional looking for the latest guidelines or a patient seeking practical tips, the collection offers actionable insights to help you navigate second-line anti‑tuberculosis treatment.
A detailed comparison of Trecator SC (Ethionamide) with other second‑line tuberculosis medicines, covering efficacy, side‑effects, dosing and WHO guidance.
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