Two-month Regimens Using Novel Combinations to Augment Treatment Effectiveness for Drug-sensitive Tuberculosis

Inclusion criteria

• Age 18 to 65 years
• Clinical symptoms consistent with pulmonary TB and/or evidence of pulmonary TB on chest X-ray (CXR)
• Sputum GeneXpert test positive
• Willing to comply with the study visits and procedures
• Resident at a fixed address
• Willing to have directly observed therapy
• Willing and able to provide written informed consent

Exclusion criteria

• Taken more than 10 daily doses of standard anti-TB medication or fluoroquinolones during the 3 months prior to randomisation
• Previous active TB disease for which treatment was given prior to the current episode
• Known or suspected extra-pulmonary TB
• Severe clinical pulmonary TB
• Sputum smear 3+ on microscopy*
• Cavity size > 4cm on screening CXR*
• Presence of rifampicin resistance on GeneXpert test
• Poorly-controlled diabetes that, in the opinion of the investigator, is unlikely to be controlled with available management strategies
• Active malignancy requiring systemic chemotherapy or radiotherapy
• Known Hepatitis B surface antigen positive and/or HCV antibody positive, unless liver function tests consistently within normal range for at least 2 years
• History of myocardial infarction, congestive cardiac failure, cardiac arrhythmias or any known congenital cardiac problems
• History of severe chronic lung disease with symptom score of ≥3 on MRC breathlessness scale
• History of seizures
• Current tendinitis or history of tendinopathy associated with fluoroquinolone use
• Symptomatic peripheral neuropathy causing greater than minimal interference with usual social and functional activities
• Current alcohol or drug abuse
• Women who are currently pregnant or breast-feeding
• Women of childbearing potential unwilling or unable to use appropriate effective contraception for the first 6 months of the trial
• Known allergy to one or more of the study drugs
• Taking a concomitant medication that has a known or predicted interaction with any of the study drugs to which the patient might be randomised, or is known to prolong the QTc interval
• Taking any immunosuppressive drugs or use of systemic corticosteroids for more than 2 weeks prior to screening
• Colour blindness detected by Ishihara test

23.12-lead ECG at screening shows QTc greater than 450ms and/or any other clinically-significant abnormality such as arrhythmia or ischaemia

24.Any of the following laboratory parameters at screening:

• Absolute neutrophil <1000 cells/mL, haemoglobin <7.0 g/dL, OR platelet count <50,000 cells/mm3
• Creatinine clearance of <60ml/min (calculated using Cockcroft-Gault equation)
• ALT greater than 3 times the upper limit of normal
• Uncorrected serum potassium <3.5 mmol/L

25.HIV antibody positive at screening*

26.Any other significant condition (e.g. psychiatric illness, chronic diarrhoeal disease), that would, in the opinion of the investigator, compromise the patient's safety or outcome in the trial or lead to poor compliance with study visits and protocol requirements

27.Participation in other clinical intervention trial or research protocol

Note: *Criteria may be modified in later stages of the trial

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