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MDR-TB — SCE Infectious Diseases MCQ

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HardTuberculosisMDR-TBSCE Infectious Diseases

A 60-year-old man on Infliximab for Crohn disease develops fever, cough, and bilateral upper lobe cavitating consolidation on chest X-ray. Sputum is smear-positive for AFB. GeneXpert detects MTB with Rifampicin resistance. What is the most appropriate next step while awaiting full drug susceptibility testing?

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Correct answer: D — Stop Infliximab and start a regimen containing at least 4 drugs likely to be effective including a fluoroquinolone and an injectable or Bedaquiline

Rifampicin-resistant TB (which may represent MDR-TB until Isoniazid susceptibility is known) requires stopping anti-TNF therapy (Infliximab) and starting a regimen with at least 4 likely effective drugs. This should include a later-generation fluoroquinolone (Moxifloxacin or Levofloxacin), and consideration of Bedaquiline, Linezolid, or an injectable agent depending on local MDR-TB protocols. The BPaLM regimen (Bedaquiline, Pretomanid, Linezolid, Moxifloxacin) is now recommended for Rifampicin-resistant, fluoroquinolone-susceptible TB. Referral to a specialist MDR-TB centre is essential.

Reference: NICE NG33 2016 – TB; WHO 2022 – Consolidated guidelines on DR-TB treatment; ATS/CDC/ERS/IDSA 2025 – Updated TB treatment guidelines