A 52-year-old woman was diagnosed with active pulmonary tube…

A 52-year-old woman was diagnosed with active pulmonary tuberculosis and started on a standard first-line regimen including isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB). After several months of therapy, her sputum cultures remain positive for Mycobacterium tuberculosis, indicating treatment failure. Drug susceptibility testing reveals resistance to multiple first-line agents. Which of the following is the most appropriate next step in her treatment?