6.8.2 Monitoring safety

Culture is now recommended throughout treatment, preferably at monthly intervals for the early detection of treatment failure (94). In addition, findings from clinical examinations (e.g. ECG, urinalysis, blood tests and radiographs) need to be taken into consideration when monitoring safety. The medicines included in the selected regimen determine what monitoring tests are needed; for example, clinical and biochemical assessment for linezolid; clinical assessments for peripheral neuropathy and psychiatric disturbances; electrocardiography and monitoring of electrolytes, particularly when the regimen contains multiple QT interval prolonging agents (e.g. bedaquiline, delamanid, moxifloxacin and clofazimine). Any adverse events during treatment should be managed immediately to relieve suffering, minimize the risk of treatment interruptions, and prevent morbidity and mortality. Schedules for clinical, biochemical and microbiological testing are provided in the aDSM module of the companion handbook (5). Treatment monitoring should be carried out in the context of mainly ambulatory care, using a decentralized model of care recommended in previous WHO guidance, which remains valid 2017.

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