Under the National Tuberculosis Elimination Programme (NTEP), a patient with pulmonary TB on the 6-month standard regimen (2HRZE/4HR) fails treatment — sputum remains positive at the end of Month 5. According to current NTEP guidelines, what is the FIRST recommended action?

• A Switch immediately to Category II regimen (2HRZES/1HRZE/5HRE)
• B Add levofloxacin to the current regimen for 3 more months
• C Perform Drug Susceptibility Testing (DST) / Line Probe Assay before changing regimen ✓
• D Refer for surgical resection of the involved lobe

Explanation

Current NTEP guidelines (aligned with WHO 2022 recommendations) mandate that before any regimen change in a treatment failure, DST including both first- and second-line drug susceptibility testing must be performed using molecular methods (Xpert MTB/RIF or LPA). Category II regimen has been phased out in India. Empirical addition of levofloxacin without DST risks amplifying fluoroquinolone resistance. Surgery is reserved for specific drug-resistant TB scenarios after chemotherapy assessment.

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.