These drugs are used to treat all persons with tb disease. Management issues raised by pregnant women with mdr tuberculosis are challenging due to the limited clinical experience available with the use of second line drugs. Pdf treatment of multidrugresistant tuberculosis mdrtb is challenging because of the high. The document also briefly describes relevant national legislation protecting tb patients rights before outlining the structure of drtb management, including suggested staffing norms for both centralized and decentralized mdrtb treatment and an organagram of decentralized treatment. Companion handbook to the who guidelines for the programmatic. Who treatment guidelines for drug resistant tuberculosis. Determinants of multidrugresistant tuberculosis in.
However, the complexity and prohibitive cost of mdrtb treatment means that few of the worlds mdrtb. Treatment outcomes for mdrtb patients started on treatment in 2009, by who region and global the number of countries reporting outcomes for at least one mdrtb case, followed by the total cases with outcome results, shown beside each bar. Treatment for mdrtb is commonly administered for 2 years or longer and involves daily injections for six months. After sputum decontamination and digestion with nalc for mdr tb and xdr tb test i store the decontaminated sputum in pbs. Merging departments of tb and respiratory medicine and, therefore. Chapter 17 management of secondline antituberculosis drugs. Length of intensive phase treatment for mdrtb patients by masoud dara, md moderator 24 aug, 2011 last edited by sophie beauvais on 04 nov 2011. Guidelines for treatment of drugsusceptible tuberculosis and patient. In contrast to drugsensitive tuberculosis, the guidelines for the treatment of multidrugresistant tuberculosis mdrtb have a very poor evidence base.
Multidrugresistant tb mdrtb is multifactorial and fuelled by improper treatment of patients, poor management of supply and quality of drugs, and airborne transmission of bacteria in public places. Second line drug susceptibility testing to inform the treatment of. Management of multidrugresistant tuberculosis mdrtb and extensively drugresistant. The history of tb and mdrtb treatment confirms strict hospitalization of patients as the accepted strategy, although depending on the geographical, economic and social settings, homebased care provided by trained lay and community health workers could achieve comparable results and, in theory. Clinical practice guidelines for the diagnosis, treatment. Delamanid, recently available for the treatment of multidrugresistant tuberculosis mdr tb, has had limited use outside clinical trials. Treatment correlates of successful outcomes in pulmonary multidrugresistant tuberculosis. Collaborative group for the metaanalysis of individual patient data in mdrtb treatment2017, ahmad n, ahuja sd, et al. Lack of qa laboratories limited access to mxdrtb treatment weak control over the use of secondline drugs high cost of sl drugs problem of dr paediatric cases is often underestimated increasing number of hiv infected dr cases treatment of migrants stigma, not regulated, high default rate. Mdrtb challenges 2nd line drugs much less effective, expensive, toxic drug costs r 400 drugsusceptible tb, new r 700 drugsusceptible tb, rerx r 20 000 r30 000 mdrtb, standardised limited number of 2nd line drugs available prolonged treatment required up to two years hospitalisation 46 months required patients typically difficult, often with social problems. Another way to prevent getting mdr tb is to avoid exposure to known mdr tb patients in closed or crowded places such as hospitals. Using genomics to understand the origin and dispersion of.
Results show good tolerability and treatment response at 6 months. Presented at the 4th international workshop on clinical pharmacology of tb drugs, 16 september 2011, chicago, il, usa optimizing existing drugs for the treatment of mdrtb kelly dooley, md, phd 4th international workshop on tb drugs 16 september 2011, chicago, il d i v i s i o n o f c li n i ca l p h ar m ac ol o g y. Evaluation of a standardized treatment regimen of anti. Treatment of drugresistant tuberculosis treatment of. Surveillance and response prior treatment mdrtb among subcategories of retreatment cases 9 settings, 20022008 31% 32% 1500 2000 2500 c ases not mdr mdr 27% 44% 28% 0 500 retreatments relapses failures defaulters others number of only % of mdr is diagnosed with dst. New treatments for multidrugresistant tuberculosis mdr tb are urgently needed. Combining the evidence on dot provider and dot location, dot should preferably be. Multidrugresistant tuberculosis mdrtb is identified from the time of introduction of antituberculosis treatment and is a known worldwide public health crisis affecting women of reproductive age group.
Treatment of mdr tb is complex and stepwise approach can be helpful and may change with upcoming new datastudies it is much easier to prevent than to treat ask for help obtain expert consultation when dr tb is suspected preventable, treatable, curable. Multidrug resistant tuberculosis mdrtb is a strain of tb that cannot be treated with the two most powerful firstline treatment antitb drugs. Familiarity and experience with managing mdr tb cases, access to timely drug susceptibility testing and second line drug procurement, and ability to minimize other case management challenges in the long term have been associated with prompt identification and successful treatment of mdr tb cases in. Many secondline drugs are toxic and have severe side effects. Multidrugresistant tuberculosis mdrtb is a form of tuberculosis tb infection caused by bacteria that are resistant to treatment with at least two of the most powerful firstline antitb medications drugs, isoniazid and rifampin. This study identifies factors associated with the occurrence of mdrtb in patients who underwent firstline tb treatment in addis ababa city. Ethiopia is 15th among the 27 mdrtb highburden countries. Treatment for ltbi in contacts of mdrtb patients, federated states of micronesia, 20092012.
Experts involved in the development of the guidelines. Provisional cdc guidelines for the use and safety monitoring of bedaquiline fumarate. Established multidrugresistant mdrtb requires a longer duration of treatment generally 1824 months and necessitates the use of alternative chemotherapy regimens, which are more costly and. Percentage of estimated mdrtb cases enrolled on treatment in 2011 key findings. Daley, md national jewish health denver, co, usa 2006 2008 2011 20 2014 2016 conflict of interest disclosure otsuka chair, data monitoring committee for delamanid mdrtb trials closed member, safety monitoring committee for delamanid pediatric mdrtb trials open. Multidrugresistant mdr tuberculosis tb poses a serious threat to the who goal of eliminating tb by 2035 1. Reported cases of mdrtb 2012 total cases tested for mdrtb 55 611 laboratoryconfirmed mdrtb cases 16 588 patients started on mdrtb treatment 14 143 9. Mdrtb, multidrugresistant tb, is defined by resistance to the two most commonly used drugs in the current fourdrug or firstline regimen, isoniazid and rifampin. Misuse of tb drugs is a principal cause of drug resistance. Sixmonth response to delamanid treatment in mdr tb.
It is the result of interrupted, erratic, or inadequate tb therapy, and its spread is undermining efforts to control the global tb epidemic. In 2009, the vietnamese government issued a policy on mdrtb called programmatic management of drugresistant tuberculosis pmdt to enhance and scale up diagnosis and treatment services for mdrtb. Multidrugresistant tuberculosis mdrtb world health organization. World health organization recommends shortened ninemonth. The generation of mdrtb resistance to tb medications is due to chromosomal mutations. Mdrtb multidrug resistant tuberculosis ndoh national department of health nhls national health laboratory services phc primary health care ppm publicprivate mix. However, the management of contacts of mdr tb and xdr tb patients is particularly challenging as the evidence base for best practises is very limited and there are few therapies available. Management of contacts of mdr tb and xdr tb patients. Guidelines for treatment of rifampinresistant tb recommend at least five effective tb. Chapter 9 treatment of drugresistant tuberculosis in special conditions. In europe alone, the number of mdrtb notified cases amounted to.
Levels are much higher in those previously treated about 20%. Preventive therapy for child contacts of multidrugresistant tuberculosis. Here we assess the pmdt performance in 20 to determine the. Multidrug resistant tb fact sheet western cape government. The bacteria that cause tuberculosis tb can develop resistance to the antimicrobial drugs used to. During this time most patients with mdr tb are admitted to hospital so that they can be closely monitored for adherence to. Two new drugs, bedaquiline and delamanid, have recently been released, and several new drugs and treatment regimens are in the pipeline. From policies for bcg vaccine in the 30s and clinical trials of tb chemotherapy in 50s to the development of dots in 80s and the innovative casefinding of fidelis in this century, the union has developed and disseminated the best approaches to tb treatment and control. Dear colleagues, the updated 2011 guidelines recommend patients with mdrtb are recommended receive an intensive phase of treatment lasting for at least 8 months duration. Criteria for the control of drugresistant tuberculosis. A series of cohort studies conducted in bangladesh identified a ninemonth regimen with very promising results. Vietnam is ranked 14th among 27 countries with high burden of multidrugresistant tuberculosis mdrtb. Percentage of estimated mdrtb cases enrolled on treatment in 2011.
Treatment success rates of multidrugresistant tuberculosis mdrtb is a key issue that cannot be ignored. We present the early treatment results for 53 patients from 7 countries who received a delamanidcontaining treatment for mdr tb. Health care providers can help prevent mdr tb by quickly diagnosing cases, following recommended treatment guidelines, monitoring patients response to treatment, and making sure therapy is completed. The mdrtb is a humanmade problem and results largely from poorly managed cases of tb.
Pdf medical treatment of pulmonary multidrugresistant. All cases of retreatment grade a recommendation all cases of treatment failure grade a all other cases of smear positive patients suspected to have one or multidrug resistant tb mdrtb grade a. Optimizing existing drugs for the treatment of mdrtb. As new drugs and regimens reach the market, the need to make them available to patients must be balanced with. Multidrugresistant tb mdr tb is caused by an organism that is resistant to at least isoniazid and rifampin, the two most potent tb drugs. In relation to mdrtb, the global plan to stop tb 2011. Treatment outcomes for multidrugresistant tuberculosis. Patients with mdr tb will have to take at least 5 different drugs, including a daily injection for 4 months 5 days a week. Treatment of drugresistant tuberculosis american journal of respiratory and critical care medicine, 2019 full guidelines external icon. New recommendations for the prompt detection and appropriate treatment of mdrtb cases will also improve access to lifesaving care.
Challenges in detection and treatment of multidrug. Guidelines for the programmatic management of drugresistant. The injectable agent should be continued for a minimum of 6 months, and for at least 4 months after the patient first becomes and remains smear or culturenegative. Thus, combining powerful toxic drugs might not ensure a high proportion of treatment success if a. Extensively drug resistant tuberculosis xdrtb is a form of tb caused by bacteria that are resistant to several of the most effective antitb drugs. Management of patients with multidrugresistantextensively drug. There is no transmissible resistance factor as is seen. Who consolidated guidelines on drugresistant tuberculosis. Professor bengal college of pharmaceutical sciences and research 2. Increase in tb cases tested for r and h yearly from 0. Management of contacts of multidrugresistant tuberculosis.
Adequate, timely diagnosis and optimal treatment of mdrtb will help curb the epidemic. Worldwide, there were 650,000 multidrugresistant tuberculosis mdrtb cases in 2010, and in 2008 the world health organization estimated that 150,000 deaths occurred annually due to mdrtb. Sputum tb culture is recommended in the following smear positive patients. Executive summary pdf pdf icon731 kb full guidelines pdf pdf icon 1 mb. In mdrtb treatment, the intensive phase is defined by the duration of treatment with the injectable agent. Regimens for isoniazidresistant tuberculosis hrtb in patients with confirmed rifampicinsusceptible and isoniazidresistant tuberculosis, treatment with rifampicin, ethambutol, pyrazinamide and levofloxacin is recommended for a duration of 6 months.
Since 1920, the union has been a global leader in the fight against tuberculosis tb. All household contacts of patients with mdr tb grade c. Antituberculosis drug resistance is a major public health problem that threatens the progress made in tuberculosis care and control worldwide. Some forms of tb are also resistant to secondline medications, and are called extensively drugresistant tb. Main challenges in management of mdrxdr tb delay with diagnosis.
Length of intensive phase treatment for mdrtb patients. Treatment of drugresistant tb in special conditions and situations. Multidrug resistant tuberculosis treatment there are two types of such resistant tb infections. Efforts must be focused on the effective use of antituberculosis drugs in every new patient, so as to. There is a paucity of evidence that assessed studies on the treatment of mdrtb, which focus on the effectiveness of the directly. In 2015, who planned to update their recommendations of mdrtb treatment.