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?tuberculosis strains.[40] However, highly discordant drug susceptibility test results were observed between L?wenstein�CJensen medium and MGIT960 for M.?tuberculosis isolates with certain rpoB mutations (511Pro, 516Tyr, 533Pro, 572Phe and several 526 mutations), with MGIT-drug susceptibility test failing to give a result or declaring the strains susceptible.[41] In another study comparing the MGIT 960 System against L?wenstein�CJensen proportion method, the critical concentrations of moxifloxacin (0.5?��g/mL), levofloxacin (1.0?��g/mL), kanamycin (2.5?��g/mL) and capreomycin (2.5?��g/mL) were concordant and reliable for testing second line drug resistance, while further studies are required for ethionamide and ��-aminosalicylic acid.[42] In an observational study by Horita N et?al. in Japan, decreased activity of daily living was found to be a strong risk factor for liver injury among adult inpatients treated PD98059 in vivo with a standard regimen for newly diagnosed smear-positive pulmonary TB.[43] To balance the competing risks related to delayed antiretroviral therapy and antiretroviral therapy-related immune reconstitution inflammatory syndrome, early initiation of antiretroviral therapy is indicated, preferably within 2 weeks after starting TB treatment, for patients with a cluster of differentiation see more 4 cell count of Tryptophan synthase isoniazid, linezolid and pyrazinamide with in vitro activity) in the best combinations and dosing schedules, together with adjunctive surgery in carefully selected cases.[45] Linezolid 300?mg daily[46] or intermittent administration of higher doses[47] may help to reduce its often treatment-limiting toxicity. Bedaquiline has recently been approved by the US Federal Drug Administration to treat adults with MDR-TB when other alternatives are not available, but concerns remain over possible fatal arrhythmia risk associated with prolonged Q-T interval.[48] The use of delamanid for 6 months or more significantly improved outcomes and reduced mortality in MDR-TB as compared with its use for 2 months or less in an observational study, but the European Medicines Agency considers the currently available evidence inadequate for substantiating use of delamanid for treating MDR-TB.[49] Claire E.