There are at least three important considerations in suspending anti-TB therapy:
- Doing no harm: The medicines used to treat TB, and especially DR-TB, have significant adverse effects. Continuing them while the treatment is failing may cause additional unnecessary suffering and create false expectations in patients and families.
- Public health: Patients in whom DR-TB regimens fail are likely already to have highly resistant strains, and ongoing therapy can result in resistance to even more medications. The resultant highly resistant strains could subsequently infect others and be extremely difficult to treat. In addition to the creation of further resistance, continued treatment in this situation also uses resources that may be very scarce. Thus, in general, treatment should be discontinued in this situation. However, if there is no clinical deterioration and the clinician prefers to continue the regimen, strict respiratory infection control is critical.
- Non-abandonment: Provision of palliative and end-of-life care is imperative to optimize the quality of life with proper TB infection control (16, 91).