History of inadequate treatment for ltbi or active tb disease encourage treatment with ltbi regimen as outlined in steps. Ahead of enrolment on mdrtb treatment, all patients should be appropriately counselled to enable participatory decisionmaking. Now that drugs are available surgery is only occassionally used as treatment for tb. Patientcentred support for medication adherence and active tb drug safety monitoring and management adsm are essential for anyone starting an mdr tb regimen. Nov 15, 2019 the document includes recommendations on the treatment of multidrugresistant tb mdr tb as well as isoniazidresistant but rifampinsusceptible tb.
The retreatment regimen with firstline drugs formerly called category 2 regimen is ineffective in mdrtb. As a result, mdrtb has become a major focus for tb research in recent years 1, 2, with 480,000 new mdr. Pdf management of patients with multidrugresistant tuberculosis. Online video series is comprised of a series of short, online lectures presented in easy to digest segments. It is accredited by the south african medical association and the norwegian medical association. Drugresistant tuberculosis curry international tuberculosis center. Who consolidated guidelines on drugresistant tuberculosis treatment.
The course contains seven modules and covers etiology and pathogenesis of tb, diagnosis and treatment, special situations, patientphysician communication, treatment adherence, and tb infection. Who treatment guidelines for drug resistant tuberculosis. Which shows improvement in coverage and access to mdr tb treatment. Treatment of multidrugresistant tuberculosis mdr tb charles l. Multidrugresistant tuberculosis mdr tb is a growing concern in meeting global targets for tb control. Mdrtb most commonly develops in the course of tb treatment, and is most commonly due to doctors giving inappropriate treatment, or patients missing doses or failing to complete their treatment. The programmatic management of multidrugresistant tuberculosis mdrtb is entirely based on a who recommended longterm, 1824 month lasting treatment regimen. Multidrugresistant tb mdr tb is defined as mycobacterium tuberculosis m. It means 85% of diagnosed cases or only 22% of the estimated incident mdr rr tb cases initiated treatment by the year. The document includes recommendations on the treatment of multidrugresistant tb mdrtb as well as isoniazidresistant but rifampinsusceptible tb. Established multidrugresistant mdr tb requires a longer duration of treatment generally 1824 months and necessitates the use of alternative chemotherapy regimens, which are more costly and. Pdf the emergence of multidrugresistant tuberculosis mdrtb. Multidrugresistant tuberculosis mdrtb, defined by resistance to isoniazid and rifampicin, the two frontline antimicrobial drugs used to treat tb, presents substantial barriers to the eradication of global tb due to challenges around diagnosis and successful treatment 1,2,3,4.
The cost of treating xdr and mdr tb is therefore very high. The treatment of mdr tb requires a long lasting drug exposure, and is also significantly associated with high rates of adverse drug events. Tb treatment usually involves the patient with tb taking a combination of different tb drugs. 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. Sep 27, 2018 the national mdr tb treatment program based on the recommendations from the 2011 update of guidelines for the programmatic management of drugresistant tuberculosis.
Globally, 156,000 persons with mdr tb or rr tb began treatment in 2018, but the latest data show that only 56% completed treatment successfully. To ensure that these goals are met, tb disease must be treated for at least 6 months and in some cases even longer. 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. The course contains seven modules and covers etiology and pathogenesis of tb, diagnosis and treatment, special situations. Successful treatment outcomes in our study were slightly lower than those found in studies done in shanghai, new york and hamburg, 54. Mdr tb most commonly develops in the course of tb treatment, and is most commonly due to doctors giving inappropriate treatment, or patients missing doses or failing to complete their treatment. Aug 21, 2018 the treatment landscape for patients with multidrugresistant tuberculosis mdrtb will be dramatically transformed for the better, soumya swaminathan, md, who deputy directorgeneral for. Treatment of multidrugresistant tuberculosis mdr tb it is accredited by the south african medical association and the norwegian medical association. The term active tb drugsafety monitoring and management abbreviated as adsm describes a new tb programme component to provide for the active and systematic clinical and laboratory assessment of patients on treatment for xdrtb, or with new tb drugs or novel mdrtb regimens to detect, manage and report suspected or confirmed drug toxicities.
Communitybased programs can improve treatment outcomes by allowing patients to be treated in their homes and addressing socioeconomic barriers to. Treatment success rates of multidrugresistant tuberculosis mdrtb is a key issue that cannot be ignored. Guidelines for the programmatic management of drugresistant. The new recommendations provided in this guideline are for the treatment of drugresistant tb drtb, including multidrugresistant tb mdrtb and isoniazidresistant tb, and are intended to help providers identify the therapeutic options associated with improved outcomes i. Mdr tb with quality assured secondline tb drugs, and ii the rollout of quantb a drug forecasting tool in countries not supported by the systems for improved access to pharmaceuticals and services siaps implemented by management sciences for health. The series will ultimately cover major topics pertaining to epidemiology, diagnosis, treatment regimens, monitoring and case management, sideeffects, prevention and isolation, treatment of contacts, and special situations. The conventional treatment lasts 2024 months, is often toxic and half of the treated patients have poor outcomes. Daley, md national jewish health university of colorado 2006 2008 2011 property 20 2014 2016 2019 of. Tb treatment drugs, failure, length, relapse tbfacts. Executive summary pdf pdf icon731 kb full guidelines pdf pdf icon 1 mb. It means 85% of diagnosed cases or only 22% of the estimated incident mdrrrtb cases initiated treatment by the year.
Bedaquiline approved by fda in 2012 as part of combination therapy in adults with pulmonary mdrtb should be used only when an effective treatment regimen cannot otherwise be provided. Professor bengal college of pharmaceutical sciences and research 2. Recommendations are also provided on the role of surgery in treatment of mdrtb and for treatment of contacts exposed to mdrtb and treatment of isoniazidresistant tb. Management of multidrugresistant tuberculosis mdrtb and extensively drugresistant tuberculosis has never. Because mdr tuberculosis is an airborne pathogen, persons with active, pulmonary tuberculosis caused by a multidrugresistant strain can transmit the. In highincome low tb incidence countries, a disproportionate number of mdr tb cases occur in migrant foreignborn populations, with concerns about low adherence rates in these patients compared to the host nonmigrant population. This mdr tb online course exists as a free selflearning online tool in allowing physicians worldwide to learn and test their knowledge of mdr tb.
Treatment in developed countries is expensive and involves an individualized regimen based on drug susceptibility data and use of reserve drugs. The treatment landscape for patients with multidrugresistant tuberculosis mdrtb will be dramatically transformed for the better, soumya swaminathan, md. If you have latent tuberculosis, you may need to take only one or two types of tb drug. Principle of mdr tb management linkedin slideshare.
The molecular basis of resistance to isoniazid and rifampicin and some other drugs is now largely understood table 1. The major goals of treatment for tb disease are to cure the individual patient. The new recommendations provided in this guideline are for the treatment of drugresistant tb dr tb, including multidrugresistant tb mdr tb and isoniazidresistant tb, and are intended to help providers identify the therapeutic options associated with improved outcomes i. Treatment correlates of successful outcomes in pulmonary multidrugresistant tuberculosis.
The term active tb drugsafety monitoring and management abbreviated as adsm describes a new tb programme component to provide for the active and systematic clinical and laboratory assessment of patients on treatment for xdr tb, or with new tb drugs or novel mdr tb regimens to detect, manage and report suspected or confirmed drug toxicities. Treatment outcomes of drug resistant tuberculosis patients in. Sixmonth response to delamanid treatment in mdr tb. Mdrtb numbers initiated on treatment doubled between 2010 and 20 5,3 to 10,719 mdrtb treatment success rate of 49 % 2012 cohort 8,000 xdrtb treatment success rate is 20 %. Monitoring patient response to mdrtb treatment using culture. New guidelines issued for the treatment of drugresistant. Screening and treatment recommendations for people exposed to. The sooner proper treatment commences, the sooner mdrtb will be contained in the community. There is a paucity of evidence that assessed studies on the treatment of mdrtb, which focus on the effectiveness of the directly. Treatment of extrapulmonary tb and of tb in special situations 95. Jan 07, 2019 ahead of enrolment on mdr tb treatment, all patients should be appropriately counselled to enable participatory decisionmaking.
Tb online who updates its treatment guidelines for mdrrrtb. Pdf treatment outcomes of mdrtb and hiv coinfection in europe. We present the early treatment results for 53 patients from 7 countries who received a delamanidcontaining treatment for mdr tb. Epidemiology of multidrugresistant tuberculosis mdrtb in. Patientcentred support for medication adherence and active tb drug safety monitoring and management adsm are essential for anyone starting an mdrtb regimen. Another way to prevent getting mdr tb is to avoid exposure to known mdr tb patients in closed or crowded places such as hospitals. On the basis of these recommendations, an effective alloral regimen for mdrtb can be assembled. Screening and treatment recommendations for people.
Tackling mdr tb in this context may, therefore, require. The bacteria that cause tuberculosis tb can develop resistance to the antimicrobial drugs used to. Multidrugresistant tuberculosis mdr tb is tuberculosis due to organisms which show highlevel resistance to both isoniazid and rifampicin, with or without resistance to other antitb drugs. Chapter 9 treatment of drugresistant tuberculosis in special. Treatment outcomes for multidrugresistant tuberculosis. Step 1 group a include all 3 levofloxacin moxifloxacin bedaquline linezolid step 2 group d1 add to complete the regimen ethambutol delamanid pyrazinamide imipemen meropenem amikacin streptomycin ethionamide prothionamide pas.
Review mdh mdr ltbi treatment recommendations, including pages 56 step 5. Multidrugresistant tuberculosis and extensively drugresistant. Treatment for tuberculosis tb usually involves taking antibiotics for several months. If antitb drugs for the treatment of mdr tb need to be given twice daily, then. Up to date, the mdrtb treatment outcome is not sufficiently understood in ethiopia. The standard duration for conventional mdr tb treatment is 2024 months. Guidelines for the management of multidrugresistant. Current treatment of multidrug resistant tuberculosis in.
Patients with mdr and especially xdr tb are often very ill, may need to be hospitalized for an extended period earlyon during treatment and can require treatment for two years or more. Treatment of multidrugresistant tuberculosis mdrtb. In the multilevel model adjusted for age and an interaction with mdr tb, hiv was significantly associated with lower treatment success in all mdr strata non mdr tb. If the correct drugs are taken for the entire duration of treatment, then they will for most patients provide a cure for tb. Mdrtb cases started on treatment extent of the problem in south africa 0 500 1500 2000.
Most people do not need to be admitted to hospital during treatment. A retrospective study of mdr tb cases in the uk has shown that mdr tb treatment regimens are associated with successful outcomes but initial hospital admissions are prolonged and patient adherence to. Epidemiology of multidrugresistant tuberculosis mdrtb. The bacteria that cause tuberculosis tb can develop resistance to the antimicrobial drugs used to cure the disease. A survival guide for clinicians, third edition was created through a collaboration of the curry international tuberculosis center citc and the state of california department of public health, tuberculosis control branch cdph.
Multidrug resistant tuberculosis treatment there are two types of such resistant tb infections. Who updates treatment guidelines for multidrugresistant tb. Treatment outcomes of drug resistant tuberculosis patients. This field guide for the management of drugresistant tuberculosis is a practical tool intended to help health workers in the clinical and operational management of the disease with special focus on the introduction, implementation and management of the 9month treatment regimen for multidrugresistant tuberculosis. 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. This is in agreement with meressa d et al who found 76. A retrospective study of mdr tb cases in the uk has shown that mdr tb treatment regimens are associated with successful outcomes but initial hospital admissions are prolonged and patient adherence to treatment is a limiting factor. In order to diagnose mdrtb, drugresistance testing should be conducted to determine if the tb strain is resistant to any drugs other than rifampicin and isoniazid nathanson et al. Antituberculosis drug resistance is a major public health problem that threatens the progress made in tuberculosis care and control worldwide. The exact drugs and length of treatment depend on your age, overall health, possible drug resistance and the infections location in the body. Mdrtb with quality assured secondline tb drugs, and ii the rollout of quantb a drug forecasting tool in countries not supported by the systems for improved access to pharmaceuticals and services siaps implemented by management sciences for health. Results show good tolerability and treatment response at 6 months. Multidrugresistant tuberculosis mdrtb oxford academic journals.
Multidrugresistant tuberculosis treatment adherence in. Chapter 8 mono and polyresistant strains drugresistant tuberculosis other than mdrtb. The world health organization whos guidance on the management of mdrtb recommends an. Drugresistant tb disease should always be treated with a daily regimen and. Treatment of drugresistant tuberculosis american journal of respiratory and critical care medicine, 2019 full guidelines external icon. Nursing considerations veronica dominguez, rn september 11, 2019 mdr. Collaborative group for the metaanalysis of individual patient data in mdrtb treatment2017, ahmad n, ahuja sd, et al. Apr 11, 2019 this is in agreement with meressa d et al who found 76. Also, in 2016 about 19% of previously treated tb cases were estimated to have either rifampicin or multi drug resistant tb. However, growing evidence shows that low treatment success rate and high rates of adverse events are associated with this regimen. Globally, 156,000 persons with mdrtb or rrtb began treatment in 2018, but the latest data show that only 56% completed treatment successfully.
In many countries there will be a cost for tb treatment, even if the tb drugs themselves are free. Pdf treatment outcomes of mdrtb and hiv coinfection in. Who has recently recommended a shorter regimen with treatment duration of 912 months, aiming for higher effectiveness, tolerability, adherence and completion rates. Mdrtb numbers initiated on treatment doubled between 2010 and 20 5,3 to 10,719 mdrtb treatment success rate of 49 % 2012 cohort 8,000.