A patient with culture-confirmed drug-sensitive pulmonary TB has completed 2 months of HRZE. On month-2 sputum culture, Mycobacterium tuberculosis is still detected. Repeat sensitivity testing confirms pan-sensitivity. The MOST appropriate action per WHO/RNTCP guidelines is:
- A Switch to second-line drugs (fluoroquinolone-based regimen)
- B Perform bronchoscopy to assess endobronchial disease
- C Extend the intensive phase by one additional month (3 months HRZE total) before continuing to continuation phase HR ✓
- D Discontinue treatment and restart from scratch
Correct answer: C. Extend the intensive phase by one additional month (3 months HRZE total) before continuing to continuation phase HR
Explanation
Per current RNTCP/WHO guidelines, if the 2-month sputum culture remains positive in drug-sensitive TB (with confirmed sensitivity), the intensive phase (HRZE) should be extended by one additional month, making it 3 months of intensive phase before transitioning to the 4-month continuation phase with HR. This is appropriate because culture conversion may lag in some patients due to high bacillary load. A switch to second-line drugs is unwarranted if the organism is pan-sensitive.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.