You have just been diagnosed with rifampicin-resistant TB and are given a choice between 4 regimens.

Regimen 1: At least 5 drugs--including a daily injection--given for 18-24 months (the drugs are selected according to which drugs your TB is susceptible. The injectable drug is usually given for 6 months). The regimen has been shown in clinical trials to have about 80% cure rate. The regimen has been associated with multiple side effects, including irreversible ones such as hearing loss. This regimen is currently the standard longer regimen given to people with drug-resistant TB.

Regimen 2: At least 5 drugs given for 18-24 months with bedaquiline in place of the injectable agent (the drugs are selected according to which drugs your TB is susceptible). This is what the WHO currently recommends for people whose TB is resistant to an injectable or who cannot tolerate it. Bedaquiline is a newer drug for TB that has now been used widely in people with drug-resistant TB, for instance, people who cannot tolerate an injectable. In clinical trials so far, bedaquiline makes people's TB tests turn negative faster (sputum culture conversion), which is a sign of effectiveness. In one small clinical trial, the number of people who died was slightly higher in the group that received bedaquiline, but programmatic data show that using bedaquiline reduces the number of deaths. Bedaquiline is available for free in many high burden countries (Global Fund eligible countries); it costs USD $900-3,000 in other high burden countries, and USD $26,000-30,000 in high income countries.

Regimen 3: A standardized 9-12 month regimen of 7 drugs--including a daily injection (although the injection is usually given for 4-6 months, and during the last 5 months of the regimen only 4 drugs are given). The regimen has been associated with multiple side effects that are similar to those in Regimen 1. In a formal study of Regimen 3, it was not shown to be as effective as Regimen 1 (with 7% fewer or 11% more people having a poor treatment outcome when Regimen 3 was used compared with Regimen 1). Regimen 3 was much less costly for both people being treated for DR-TB and for the National TB Programs treating them.

Regimen 4: A standardized 9-12 month regimen of 7 drugs that is like Regimen 3, but uses bedaquiline instead of an injectable. This regimen is currently being tested in a clinical trial, so its effectiveness is not yet known.

* 1. Which regimen would you choose?

* 2. Why?

* 3. What questions would you want to ask before making a choice? 

You may want to consider questions about what information is available to guide your choice if you have HIV infection, HCV infection, or diabetes, or are pregnant. You may want to ask questions about access to testing or the way care is delivered.