The reason for maintaining the patient on INH despite the suspicion of MDR-TB is that INH is so potent in treating TB that it is foolish to omit it until there is microbiological proof that it is ineffective. There are also probes available for isoniazid-resistance (katG and mabA-inhA), but these are less widely available. When sensitivities are known and the isolate is confirmed as resistant to both INH and RMP, five drugs should be chosen in the following order (based on known sensitivities):

an aminoglycoside (e.g., amikacin, kanamycin) or polypeptide antibiotic (e.g., capreomycin)
PZA
EMB
a fluoroquinolones: moxifloxacin is preferred (ciprofloxacin should no longer be used;
rifabutin
cycloserine
a thioamide: prothionamide or ethionamide
PAS
a macrolide: e.g., clarithromycin
linezolid
high-dose INH (if low-level resistance)
interferon-γ
thioridazine
meropenem and clavulanic acidDrugs are placed nearer the top of the list because they are more effective and less toxic; drugs are placed nearer the bottom of the list because they are less effective or more toxic, or more difficult to obtain. Resistance to one drug within a class generally means resistance to all drugs within that class, but a notable exception is rifabutin: rifampicin-resistance does not always mean rifabutin-resistance and the laboratory should be asked to test for it. It is only possible to use one drug within each drug class. If it is difficult finding five drugs to treat then the clinician can request that high level INH-resistance be looked for. If the strain has only low level INH-resistance (resistance at 0.2 mg/L INH, but sensitive at 1.0 mg/L INH), then high dose INH can be used as part of the regimen.
Curlings ulcer is an acute gastric erosion resulting as a complication from severe burns when reduced plasma volume leads to ischemia and cell necrosis (sloughing) of the gastric mucosa. The condition was first described in 1823 and named for a doctor, Thomas Blizard Curling, who observed ten such patients in 1842.These stress ulcers (actually shallow multiple erosions) were once a common complication of serious burns, presenting in over 10% of cases, and especially common in child burn victims. They result in perforation and hemorrhage more often than other forms of intestinal ulceration and had correspondingly high mortality rates (at least 80%).A similar condition involving elevated intracranial pressure is known as Cushings ulcer. Treatment
While emergency surgery was once the only treatment, combination therapies including enteral feeding with powerful antacids such as H2-receptor antagonists or, more recently, proton pump inhibitors such as omeprazole have made Curlings ulcer a rare complication. See also
Cushing ulcer

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