First case report in Latin America: Oral treatment of multidrug-resistant tuberculosis with delamanid and bedaquiline in combination with linezolid, moxifloxacin and clofazimine following a DRESS syndrome in a peruvian patient
Abstract
Regarding treatment there are no consensus guidelines. Because acquired resistances are of concern, combination treatment is recommended with two or three antibiotics to which the agent is susceptible and at least one drug should have good intracellular activity. First line drugs in humans include rifampicin, levofloxacin, erythromycin, imipenem, vancomycin and aminoglycosides. For immunocompromised patients at least six months of antibiotic therapy are advised. The placement of a central venous catheter allows intravenous treatment on an outpatient basis, reducing risks of nosocomial infection and costs. Sideeffects from multi-drug treatment over such a long period of time may be a concern and should be closely monitored. Antibiotics withdrawal and substitution may be needed, making R. equi infection treatment a dynamic process. Relapse may occur requiring close surveillance. We scheduled hospital medical consultation whenever the patient presented any complaint and every three months with hemogram, serum biochemistry, blood and sputum cultures and chest computed tomography. After relapse with a brain abscess, brain magnetic resonance was performed every three months until its resolution. No further bronchoscopy was performed following endoscopic treatment of tracheal pseudotumor as the patient refused further invasive examinations and remained asymptomatic.
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