What is MDR TB? Discuss its complications and treatment methods. (Multidrug-resistant tuberculosis)

What is MDR TB? Discuss its complications and treatment methods.

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MDR TB:

Multidrug-resistant tuberculosis (MDR-TB) is a form of tuberculosis infection caused by bacteria that are resistant to treatment with at least two of the most powerful first-line anti-TB medications, isoniazid and rifampicin.

Risk patient:

Those patients may develop MDR-TB who-

Do not take their TB drugs regularly;

Do not take all of their TB drugs;

Develop TB disease again, after being treated for TB disease in the past;

Come from areas of the world where drug-resistant TB is common;

Have spent time with someone known to have drug-resistant TB disease.

Treatment:

High cure rates of MDR-TB were achieved only with the introduction of the fluoroquinolones.

So following drugs being used for Bangladesh regimen: gatifloxacin, clofazimine, ethambutol, and pyrazinamide. This was supplemented by high dose isoniazid, kanamycin and prothionamide during the first four months.

National Guideline and Operational Manual for Tuberculosis অনুযায়ী প্রকারভেদসমূহ লিখুন। Classification of Anti-Tubercular Drugs এর শ্রেণিবিভাগ উল্লেখ করুন।

According to National Guideline and operational Manual for Tuberculosis, 2021-

Classifications of TB:

A.  According to anatomical site of the disease: 

1. Pulmonary TB
2. Extra-pulmonary TB

B.  According to history of previous TB treatment:

1. New TB
2. Previously Treated TB:

Relapse

• Treatment after failure
• Treatment after loss to follow up
• Other previously treated

C.  According to Drug Resistance:

1. Mono-resistance
2. Poly-resistance
3. Multi-Drug Resistance TB (MDR-TB)
4. Extensively Drug Resistance TB (XDR-TB)bar od
5. Rifampicin Resistance (RR)

D. According to HIV Status:

1. HIV-positive TB patient
2. HIV-negative TB patient
3. HIV-status unknown TB patient

E.  According to other considerations:

1. Transfer in TB
2. Transfer out TB
3. Other: Patient who cannot be included in any one of the above categories

Anti-tubercular Drugs Classification:

Description Drug

First line Anti-TB drugs

1. Oral drugs
2. Isoniazid
3. Rifampicin
4. Ethambutol
5. Pyrazinamide
6. Rifabutin
7. Rifapentine

Second line Anti-TB drugs

Group A

(Include all three medicines)

1. Levofloxacin/Moxifloxacin
2. Bedaquiline
3. Linezolid

Group B

(Add one or both medicines)

1. Clofazimine
2. Cycloserine/Terizidone

Group C

(Add to complete the regimen and when medicines from group A and B cannot be used)

1. Ethambutol
2. Delamanid
3. Pyrazinamide
4. Imipenem-cilastatin/Meropenem
5. Amikacin
6. Ethionamide or Protionamide
7. amino salicylic acid

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