A drug-resistant TB patient is identified with resistance to Rifampicin on Xpert MTB/RIF. As per current NTEP guidelines, the next diagnostic step before initiating regimen is:
- A Perform Line Probe Assay (LPA) to determine additional resistance pattern including Isoniazid and second-line drugs ✓
- B Start Category II regimen immediately
- C Perform CBNAAT repeat on a second sputum sample only
- D Start Bedaquiline + Linezolid empirically without further drug sensitivity testing
Correct answer: A. Perform Line Probe Assay (LPA) to determine additional resistance pattern including Isoniazid and second-line drugs
Explanation
Under NTEP guidelines, Rifampicin resistance on Xpert MTB/RIF necessitates confirmation and characterisation of resistance pattern before treatment. Line Probe Assay (LPA) — FL-LPA for first-line drugs (Isoniazid, Rifampicin) and SL-LPA for second-line drugs (Fluoroquinolones, injectable agents) — is performed to guide regimen selection (shorter oral BPaL-M regimen vs. longer regimen). Simply repeating Xpert is insufficient. Category II is for drug-sensitive relapse. Empirical Bedaquiline without DST violates NTEP protocol.
Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.
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