Treatment of drug resistant tb treatment options for highly drug resistant tuberculosis are limited. Pdf drugresistant tuberculosis diagnosis, treatment. The emerging threat of drugresistant tuberculosis in southern africa. However, the presence of inhlike substances in the. Multidrug resistant tuberculosis is an infectious disease caused by determined strains of mycobacterium tuberculosis that are resistant to at least both isoniazid and rifampin, the two most commonly used antimicrobials to treat tuberculosis. 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. Summary of a joint workshop by the institute of medicine and the academy of science of south africa 2011 chapter. Pdf pdf icon 349 kb plan to combat extensively drug resistant tuberculosis mmwr 2009. Treatment of drugresistant tuberculosis resistance to tuberculosis tb drugs is a formidable obstacle to effective tb care and prevention globally. Jun 22, 2014 drug resistant tuberculosis,diagnosis and treatment 1.
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. Report warns of rise in drugresistant tuberculosis cidrap. Sep 18, 2019 a rare and serious type of the disease is called extensively drug resistant tb. Tuberculosis tuberculosis tuberculosis is the most common cause of morbidity and mortality in people living. Global tuberculosis incidence has declined marginally over the past decade, and tuberculosis remains out of control in several parts of the world including africa and asia. Who consolidated guidelines on drug resistant tuberculosis treatment 6 key definitions2 drug susceptibility testing dst refers to invitro testing using either phenotypic methods to determine susceptibility or molecular techniques to detect resistanceconferring mutations to a medicine 7,8.
To address the increasing drugresistant tb epidemic, the lesotho national tuberculosis program recommends the use of the xpert mtbrif assay as. Tuberculosis that does not respond to standard drug treatment. While tb is curable when patients adhere to the treatment regimen, mdr. Mar 23, 2017 practices for the management of individual patients in settings with a high tuberculosis burden are not sufficient to prevent the emergence, amplification, and spread of drugresistant tuberculosis is one of the key messages from the lancet respiratory medicine commission, led by keertan dheda from the university of cape town, south africa. Who consolidated guidelines on drugresistant tuberculosis treatment 6 key definitions2 drug susceptibility testing dst refers to invitro testing using either phenotypic methods to determine susceptibility or molecular techniques to detect resistance conferring mutations to a medicine 7,8. These actions will contribute to the prevention of further resistance to tb drugs and significantly reduce the global spread of mdrtb. Treating drugresistant tb is costlier and can take three to four times as long not all people survive. The current global status of multidrugresistant tb mdrtb tb resistant to at least isoniazid h and rifampicin r is worrying, and the overall response to this. Practices for the management of individual patients in settings with a high tuberculosis burden are not sufficient to prevent the emergence, amplification, and spread of drugresistant tuberculosis is one of the key messages from the lancet respiratory medicine commission, led by keertan dheda from the university of cape town, south africa.
While tb is curable when patients adhere to the treatment regimen, mdr and xdrtb are more problematic. A policy framework on decentralised and deinstitutionalised management for south africa will guide provinces in the complex process of decentralisation of drugresistant tb care and treatment. Over 400,000 new cases of mdrtb occur each year and, although their rates are currently unknown, xdrtb cases have been detected in every country where there is. 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. Tb diagnosis is still based on clinical suspicion, radiology, and microbiological testing.
Treatment of drug resistant tuberculosis resistance to tuberculosis tb drugs is a formidable obstacle to effective tb care and prevention globally. Who consolidated guidelines on drugresistant tuberculosis. Diagnosis and treatment of drugresistant tuberculosis archivos. However, detecting drug resistant tuberculosis has been much harder as it requires pure cultures of mycobacterium tuberculosis. Mar 23, 2017 of the estimated 480,000 cases of multidrugresistant mdr tb, approximately 10% are either extensively drugresistant xdrwith additional resistance to secondline drugsor totally drug resistant. Pdf laboratory diagnostic aspects of drug resistant tuberculosis. Diagnosis and treatment of drtb are considerably more difficult than for drugsusceptible tuberculosis tb and require higher level infrastructure and proficiency from laboratory specialists and clinicians. Drugresistant tb dr tb is spread the same way that drugsusceptible tb is spread. Who treatment guidelines for drugresistant tuberculosis, 2016 update. A rare and serious type of the disease is called extensively drugresistant tb. The reason for this inh resistance is not quite clear.
A person with drug resistant tb should be treated by a specialist with considerable experience in managing the disease. 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. Sputum samples can also be used to test for drugresistant strains of tb. 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 multidrug resistant tuberculosis. The medications used for drug resistant tuberculosis include the injectable antibiotics capreomycin, kanamycin, and amikacin. Multidrugresistant mdr tuberculosis, ebola with wings, is a significant threat to tuberculosis control efforts. Treatment of highly drugresistant pulmonary tuberculosis. Multidrug resistant 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. The epidemiology, pathogenesis, transmission, diagnosis, and. This field guide for the management of drug resistant 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 multidrug resistant tuberculosis. Request pdf diagnosis and treatment of drugresistant tuberculosis in the last 2 decades, drugresistant tuberculosis has become a threat and a challenge to worldwide public health. Drugresistant tuberculosis focus on drugresistant tb is part of the growing challenge of antimicrobialresistant superbugs that do not respond to existing medications, resulting in fewer. The tb bacteria are put into the air when a person with tb disease of the lungs or throat coughs, sneezes, speaks, or sings.
At 83%, the success rate for treatment of drugsusceptible tb was below the who target of 90%, but much higher than the success rate for drugresistant tb 72%. The emergence of multidrug resistant tuberculosis mdrtb and, more recently, extensively drug resistant tb xdrtb is widely considered a serious threat to global tb control. Pdf multidrug resistant strains of mycobacterium tuberculosis mdrtb are present world wide, and in many areas constitute a serious threat to the. The sentinel project on pediatric drugresistant tuberculosis has recommended that children. Diagnosis and treatment of drugresistant tuberculosis. Algorithm for laboratory diagnosis and treatmentmonitoring.
Estimated incidence, 2016 estimated number of deaths, 2016 1. Although tuberculosis control has been effective in some regions of the world, these gains are threatened by the increasing burden of multidrugresistant mdr and extensively drugresistant xdr tuberculosis. Who technical guide on nextgeneration sequencing technologies for the detection of mutations associated with drug resistance in mycobacterium tuberculosis complex. Once a patient has been shown to have mdrtb, for example, subsequent repetition of isoniazid. Pathways to multidrugresistant tuberculosis diagnosis and. Skip directly to site content skip directly to page options skip directly to az link. Treatment of drugresistant tb treatment options for highly drugresistant tuberculosis are limited.
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. Tb is spread through the air from one person to another. Some forms of tb are also resistant to secondline medications, and are called extensively drugresistant tb. Drugresistant tuberculosis drtb poses a major threat to control of tuberculosis worldwide. Epidemiology and management of childhood multidrug. The emergence of multidrugresistant tuberculosis mdrtb and, more recently, extensively drugresistant tb xdrtb is widely considered a serious threat to global tb control.
Multidrug resistance severely limits available treatment options. Although tuberculosis control has been effective in some regions of the world, these gains are threatened by the increasing burden of multidrug resistant mdr and extensively drug resistant xdr tuberculosis. Centers for disease control and prevention, european respiratory society, and infectious diseases society of america jointly sponsored this new practice guideline on the treatment of drugresistant tuberculosis drtb. Multi drug resistant 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.
If your chest xray shows signs of tuberculosis, your doctor may take samples of your sputum the mucus that comes up when you cough. Guidelines for the programmatic management of drug resistant tuberculosis pdf. A policy framework on decentralised and deinstitutionalised management for south africa will guide provinces in the complex process of decentralisation of drug resistant tb care and treatment. Some forms of tb are also resistant to secondline medications, and are called extensively drug resistant tb. Of the estimated 480,000 cases of multidrugresistant mdr tb, approximately 10% are either extensively drugresistant xdrwith additional resistance to secondline drugsor totally drug resistant. Citc is a project of the university of california, san francisco, funded by the centers for. The medications used for drugresistant tuberculosis include the injectable antibiotics capreomycin, kanamycin, and amikacin. The longterm persistence of mycobacterium tuberculosis in communities with high tuberculosis prevalence is a serious problem aggravated by the presence of drugresistant tuberculosis strains. National action plan for combating multidrugresistant tuberculosis. Molecular diagnosis of drug resistant tuberculosis 122019. Several fact sheets on drugresistant tb, including symptoms, risks, treatment, and more. We assessed the cost, globally and in 36 highburden countries, of two strategies for diagnosing tb and multidrug resistant mdrtb. May 04, 2016 several fact sheets on drugresistant tb, including symptoms, risks, treatment, and more.
Inform the patient about the possible diagnosis of drtb and its treatment. Diagnosis the first steps in diagnosing drug resistant tb are to recognize that the patient is at risk and to expedite the laboratory diagnosis. A more detailed description of these findings and preliminary data from the u. Tuberculosis that does not respond to standard drug treatment drugresistant tb has become a very serious problem in recent years in certain populations. Xpert mtbrif for diagnosis of tuberculosis and drug. The epidemiology, pathogenesis, transmission, diagnosis. Management of drugresistant tuberculosis world health. Drug resistant tb multidrug resistant tb mdr tbresistant to at least rifampin rif and isoniazid inh 3.
The injectable drugs can cause hearing loss and balance problems. Xdr tb is also resistant to the best secondline medications. Drugresistant tb globally in 2018, 484 000 417 000556 000 people developed tb that was resistant to o rifampicinresistant rrtb, the most effective firstline drug, and of. A situation assessment tool to engage all relevant care providers in drug resistant tuberculosis drtb management at country level. Drug resistant tb has become a very serious problem in recent years in certain populations. Deaths from drugresistant tb now account for about onethird of all antimicrobial resistance deaths worldwide. For example, tb resistant to the drug isoniazid inh is seen among patients from southeast asia.
The number of drug resistant tb drtb cases is increasing worldwide. The number of drugresistant tb drtb cases is increasing worldwide. Towards universal access to diagnosis and treatment of multidrug resistant and extensively drug resistant tuberculosis by 2015. The molecular basis of resistance to isoniazid and rifampicin and some other drugs is now largely understood table 1. Algorithm for laboratory diagnosis and treatmentmonitoring of pulmonary tuberculosis and drugresistant tuberculosis using stateoftheart rapid molecular diagnostic technologies expert opinion of the european tuberculosis laboratory initiative core group members for the who european region. Drugresistant tuberculosis drtb drugsensitive and drugresistant tuberculosis chapter 7. It is resistant to almost all drugs used to treat tb, including the two best firstline drugs. Previous prevailing views that resistance was mainly acquired through poor treatment led to decades of focus on drugsensitive rather than drugresistant dr tuberculosis, driven by the world health organizations directly observed therapy, short course strategy. The document includes recommendations on the treatment of multidrugresistant tb mdrtb as well as isoniazidresistant. Xpert mtbrif is a rapid test to diagnose tuberculosis tb and rifampicin resistant tb. Algorithm for laboratory diagnosis and treatmentmonitoring of pulmonary tuberculosis and drug resistant tuberculosis using stateoftheart rapid molecular diagnostic technologies expert opinion of the european tuberculosis laboratory initiative core group members for the who european region. National tb surveillance system ntss were published in 2006. What is the treatment for drugresistant tuberculosis. Drug resistance is a major challenge for tuberculosis tb treatment and eradication.
For more than hundred years the standard way to detect tb in patients has been the finding of acid fast bacilli in clinical samples ziehl neelsen staining. Drugresistant tb dr tb is spread the same way that drug susceptible tb is spread. Extensively drugresistant tuberculosis united states. Conventional diagnostic tests for tuberculosis tb, including those for the detection of drugresistant forms of tb and the diagnosis of tb in people living with hiv infection, have limitations that are major constraints to progress in global tb care and control 15. In 2017, there were approximately 558,000 cases of drugresistant tb. Pdf multidrugresistant tb is definded as tb bacilli revealing resistance to at least isoniazid and rifampicin whereas extensively drugresistant tb. Who consolidated guidelines on drugresistant tuberculosis treatment 6 key definitions2 drugsusceptibility testing dst refers to invitro testing using either phenotypic methods to determine susceptibility or molecular techniques to detect resistanceconferring mutations to a medicine 7,8. Extensively drug resistant tuberculosis united states, 19932006.
Drugresistant tuberculosis is a global health problem that hinders the progress of. Xpert with followon diagnostics, and conventional diagnostics. A person with drugresistant tb should be treated by a specialist with considerable experience in managing the disease. Testing for tb infection suspicion of or evaluation for tb sometimes begins with the use of an interferon gamma release assay igra such as quantiferontb gold qftg or tspot. Drug resistant tb dr tb is spread the same way that drug susceptible tb is spread. This helps your doctor choose the medications that are most likely to work. Nov 27, 2007 the emergence of multidrug resistant tuberculosis mdrtb and, more recently, extensively drug resistant tb xdrtb is widely considered a serious threat to global tb control.
Provided by the centers for disease control and prevention cdc. This means that many of the common medications including isoniazid, rifampin, fluoroquinolones, and at least one. Sputum smear microscopy, the most widely used test, has relatively low sensitivity in field conditions. Diagnosis of multidrugresistant tuberculosis and extensively. The worldwide emergence of extensively drug resistant tuberculosis xdr tb and a provisional definition for this form of tb were first reported in november 2005 1,2. Pdf pdf icon 275 kb report of expert consultations on rapid molecular testing to detect drug resistant tuberculosis in the united states. Drug resistance in an individual patient is often discovered only after a long delay, particularly if the diagnosis is based on current culturebased drug sensitivity testing methods. In this study in south africa, a new agent, pretomanid, was combined with bedaquiline and linezo. Current tools available for the diagnosis of drugresistant tuberculosis. Who treatment guidelines for drug resistant tuberculosis.
323 1143 1504 732 1366 508 416 1211 805 633 519 1350 898 1117 1205 702 124 986 1199 227 1241 1485 472 910 603 384 324 949 411 770 372 934 1433 591 785 1488 703 527 806 576 444