Send samples to a laboratory that has extensive experience in drug-susceptibility testing. Never add a single drug to a failing regimen . Treatment must be daily, not intermittent.
Surgical resection can play an important role in the management of selected cases.
Criteria for resection include extensive drug resistance, poor response to medical treatment, and disease that is sufficiently localized so that respiratory function will not be crippled when the diseased portion of the lung is removed. Monthly clinical evaluations. Soon after treatment is started, whenever the regimen is changed, and in the event that the patient deteriorates clinically, the physician should consider monitoring the serum levels of antituberculosis medications in order to maintain the appropriate concentration of each drug for maximum efficacy and minimum toxicity. Managing adverse reactions to second-line medications. Occasionally, even though the regimen is not failing, a patient has a severe adverse reaction.