The current guidance on monitoring the response to treatment of DS-TB is unchanged. WHO does not recommend baseline electrocardiogram (ECG) monitoring for those receiving the shorter regimen (unless clinically indicated), and laboratory monitoring such as liver function tests (LFT) is the same for both regimens (1). Some countries may have different requirements for LFT and ECG monitoring because of the “black box” warnings for moxifloxacin (related to QTc prolongation). Clinical monitoring is recommended in some countries for rare but possible adverse events related to moxifloxacin that are common to other fluoroquinolones (e.g. tendonitis, Clostridium difficile diarrhoea and peripheral neuropathy) and such monitoring should be carried out according to the country’s policies.
NTPs need to monitor patients’ condition with regular clinical follow-ups and may perform at least smear microscopy after 2 months of treatment to monitor treatment response bacteriologically. Lack of clinical or bacteriological response to treatment may need to trigger further clinical and radiological assessment, complemented by sputum smear culture and DST. Although the regimen can be continued while awaiting results of these assessments, once the results are available they will provide the clinician with the evidence to change the regimen or treatment strategy. Additional information on treatment monitoring is given in Section 9.