When discontinuing Delamanid, attention should be paid to gradual reduction, efficacy evaluation, and adverse reaction monitoring, especially to prevent tuberculosis recurrence and QT interval abnormalities. Individualized discontinuation plans should be developed for special populations.

1. Pre discontinuation assessment

(1) The conversion of sputum culture to negative should last for at least 3 months, and chest imaging should show stable absorption of the lesion to avoid recurrence caused by premature discontinuation of medication.

(2) Complete a standard course of treatment for at least 6 months, with extensively drug-resistant (XDR-TB) patients needing to extend it to 9-12 months to ensure complete eradication of drug-resistant strains.

2. Standardized discontinuation process

(1) It is recommended to use a 2-4 week stepwise reduction method, with a daily dose decrease of 25%. Sudden discontinuation of medication may induce bacterial rebound and proliferation.

(2) In the combination therapy plan, Delamani was discontinued and other sensitive drugs were continued to be used for 1-2 weeks to consolidate the therapeutic effect.

3. Monitoring after discontinuation of medication

(1) Perform sputum smear and culture review every month for 6 months to detect possible bacterial recurrence in the early stage.

(2) Electrocardiogram monitoring continues for one month after discontinuation of medication to prevent the risk of arrhythmia caused by delayed QT interval prolongation.

4. Management of special populations

(1) HIV infected individuals need to maintain antiviral treatment and undergo CD4 count testing every 3 months to be alert to immune reconstitution inflammatory syndrome.

(2) Patients with liver dysfunction still need to undergo monthly ALT/AST testing to restore normal values after discontinuing medication, in order to prevent drug accumulation induced liver injury.

5. Emergency response plan

(1) When recurrent symptoms (worsening cough, low-grade fever) occur, immediately restart treatment and adjust the drug sensitivity test plan.

(2) When cardiac events such as apical torsion and ventricular tachycardia occur, in addition to discontinuing Delamani, intravenous magnesium supplementation and 72 hour electrocardiogram monitoring are required.