3.5 Treatment monitoring

Standard treatment monitoring should be ensured to assess the treatment response and any adverse events.

The available tools for treatment monitoring are bacteriological examinations (sputum smear, culture and DST), chest radiography (CXR) and clinical examination by the treating physician.

The important timepoints of the necessary TB monitoring examinations are after 2 months of treatment (especially if the patient does not improve, and underlying drug-resistance and possible failure are suspected) and at the end of treatment.

If the sputum specimen obtained at the end of the intensive phase of treatment (i.e. end of month 2) is positive on smear microscopy, and the patient does not show clinical and radiological improvement, sputum culture and DST should be performed. Based on these results, the patient should be reassessed to identify possible risk factors for failure and the treatment strategy should be changed if necessary.

Culture and DST are important for determining whether the bacilli are alive and whether any previously undetected resistance is present.

Malabsorption of drugs and drug–drug interactions can occur, especially in PLHIV or those with diabetes, in critical care or receiving concomitant medications. Where the clinician suspects malabsorption, it is useful to undertake evaluation and monitoring of the blood levels of the drugs composing the regimen; this can be done using therapeutic drug monitoring (25). Section 9 provides additional details on clinical monitoring in cases of adverse events due to anti-TB drugs, and on treatment monitoring with sputum smear, culture and radiology.

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