A patient starting an all-oral MDR-TB regimen containing bedaquiline, delamanid and moxifloxacin is counselled about monitoring. Which investigation must be performed before initiation and repeated during therapy?

• A Serial audiometry
• B Thyroid function tests
• C Serum creatine kinase
• D ECG for QT interval measurement ✓

Explanation

Bedaquiline, delamanid and fluoroquinolones such as moxifloxacin all prolong the cardiac QT interval. Combining two or three of them substantially increases the risk of torsades de pointes, so baseline and repeat ECGs with electrolyte monitoring are mandatory. Audiometry is required when injectable agents like amikacin are used, which this regimen avoids, and creatine kinase relates to linezolid or statin myopathy rather than these drugs, eliminating the other options.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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