RNTCP guideline for use of Delamanid in DR-TB in India 2018
Seven states have been identified as initial sites for the introduction of DLM under the RNTCP PMDT through conditional access. These include Punjab, Chandigarh, Rajasthan, Karnataka, Odisha, Kerala , Lakshadweep.

Delamanid has been given approval for use along with the background regimen under conditional access through the Revised National Tuberculosis Control Programme (RNTCP) PMDT services in India. However, Dlm will continue to be available for “compassionate use” in the country till such time that the expanded access programme is rolled out under RNTCP.

Delamanid is one of two drugs developed specifically for the treatment of TB in the last 40 years. It is the first approved drug in the class of nitro-dihydro-imidazo-oxazoles for the treatment of MDR-TB. It has been developed by Otsuka Pharmaceutical Ltd. for the treatment of MDR-TB.

Delamanid is indicated for use as part of an appropriate combination regimen for pulmonary MDR-TB in adult and adolescent (6-17 years) patients when an effective treatment regimen cannot otherwise be composed for reasons of resistance or tolerability.

It has the following characteristics
• Chemical class: nitroimidazole
• Mechanism of Action: Bactericidal (Half-life: 36 hours)
- By blocking the synthesis of mycolic acids (i.e., stopping the bacteria from creating building blocks important for their cell walls).
- By poisoning them with nitric oxide, which the drugs release when metabolized
• Each film-coated tablet contains 50 mg Delamanid.
• Excipient with known effect: each film-coated tablet contains 100 mg lactose (as monohydrate).

The guidance recommends that Dlm may be added to a WHO-recommended regimen in adult patients with pulmonary MDR-TB under the following conditions:

• When an effective treatment regimen containing four second-line drugs in addition to pyrazinamide (Z) according to WHO recommendations cannot be designed

• When there is documented evidence of resistance to any FQ or second-line injectable drug in addition to MDR.

• When there is higher risk for poor outcomes (eg. drug intolerance or contraindication, extensive or advanced disease)

Note: This list is a brief compilation of some of the key points mentioned in the article. Kindly refer to the original publication here: https://pxmd.co/4yC5Y
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