Contents

Search

multi-drug resistant tuberculosis

Epidemiology: - outbreaks of multi-drug resistant tuberculosis have occurred in urban populations at risk for TB & HIV Laboratory: - DNA-based test MTBDRsl provides results in 24 to 48 hours detects mutations that make MDR-TB resistant to treatment [4] Management: 1) empiric therapy should consist of 5-6 drugs - isoniazid (INH), rifampin, pyrazinamide, ethambutol, streptomycin, fluoroquinolone* 2) treatment should consist of at least 3 drugs to which the organism is sensitive 3) addition of linezolid may be of benefit [2] - adverse effects common 4) addition of bedaquiline (Sirturo) may be of benefit [3] 5) consider surgery for which the bulk of the disease is resectable 6) continue treatment for at least 18-24 months or for 12 months after culture negative 7) associated with increased mortality [1] 8) all infected contacts exposed to multidrug-resistant TB (MDR-TB) should be given a later-generation fluoroquinolone +/- a second drug [5] * second line agents for treating multidrug-resistant tuberculosis - streptomycin - capreomycin - ethionamide - kanamycin or amikacin - levofloxacin or moxifloxacin - para-aminosalicylic acid - bedaquiline [1]

Related

Mycobacterium tuberculosis (MTB)

Specific

extensively drug-resistant tuberculosis (XDR-TB)

General

drug-resistant tuberculosis

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 16, 18. American College of Physicians, Philadelphia 1998, 2006, 2009, 2012, 2018
  2. Lee M et al. Linezolid for treatment of chronic extensively drug-resistant tuberculosis. N Engl J Med 2012 Oct 18; 367:1508 PMID: 23075177
  3. World Health Oragnization (WHO). 2013 The use of bedaquiline in the treatment of multidrug-resistant tuberculosis. Interim Policy Guideline. http://apps.who.int/iris/bitstream/10665/84879/1/9789241505482_eng.pdf - World Health Oragnization (WHO). 2013 WHO interim guidance on the use of bedaquiline to treat MDR-TB https://mail.google.com/mail/u/0/?shva=1#inbox/13f425db09d8dfc1
  4. World Health Oragnization (WHO). May 12, 2016 Rapid diagnostic test and shorter, cheaper treatment signal new hope for multidrug-resistant tuberculosis patients. http://www.who.int/mediacentre/news/releases/2016/multidrug-resistant-tuberculosis/en/
  5. Nahid Pm Mase SR, Migliori SB et al Treatment of Drug-Resistant Tuberculosis. An Official ATS/CDC/ERS/IDSA Clinical Practice Guideline. AM J Resp Crit Care. 200(10): Nov 15 2019 PMID: 31729908 Free PMC Article https://www.atsjournals.org/doi/full/10.1164/rccm.201909-1874ST