Multidrug resistant tuberculosis mdrtb is tuberculosis due to organisms which show highlevel resistance to both isoniazid and rifampicin, with or without resistance to other antitb drugs. In 20, globally around 9 million people were estimated to have developed tb and 1. Pdf pdf icon 37k multidrug resistant tuberculosis mdr tb what is tuberculosis tb. Multidrug resistant tuberculosis mdrtb is a growing concern in meeting global targets for tb control. Sep 12, 2008 multi drug resistant tuberculosis mdr tb implications and diagnosis dr. About 9% of mdrtb cases also have resistance to two other classes of drugs, or. Rao md slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising.
Multidrug resistant tuberculosis tb in children is mainly caused by transmission of drug resistant strains causing infection and disease i. Isoniazid resistant tb hrtb, refers to mycobacterium tuberculosis strains in which resistance to. Essentially, drug resistance arises in areas with weak tb control programmes. The aim of this report is to determine risk factors for mdrtb in europe. Summaries of unpublished data used for the recommendations 1. Drug resistance in mycobacterium tuberculosis arises from the manmade selection of mutants that result from spontaneous chromosomal alterations. We prepared guidance on which data to collect and what measures could improve consistency and utility for future evidencebased recommendations.
During this phase, an injectable agent amikacin, capreomycin, kanamycin or streptomycin is used. Tproblem and one of the worlds deadliest communicable diseases. The types most threatening to public health are mdr bacteria that resist multiple antibiotics. More recently, extensively drug resistant tuberculosis xdrtb that is also resistant to second line drugs has emerged in a number of countries. We studied the epidemiology of drug resistant tuberculosis tb in vladimir region, russia, in 2012. Multi drug resistant tb free download as powerpoint presentation. Also, in 2016 about 19% of previously treated tb cases were estimated to have either rifampicin or multi drug resistant tb. Patients who are infected with strains resistant to isoniazid and rifampicin, called multidrugresistant mdr tb, are practically incurable by standard firstline. Division of tuberculosis elimination tb elimination multidrug resistant tuberculosis mdr tb what is tuberculosis tb. Multidrug resistant tuberculosis, somalia, 20102011. Improving quality of patient data for treatment of.
Tuberculosis tb is a disease caused by bacteria that are spread from person to person through the air. Did the investigators control for this multiple matching in. Extensively drug resistant tuberculosis xdrtb appeared following the misuse of secondline drugs. Multidrug resistant tuberculosis is increasingly common. Multidrug resistant tuberculosis page 2 of 30 types of drug.
Rapid indication of multidrug resistant tuberculosis from liquid cultures using fastplaquetbriftm, a manual phagebased test. The 2012 global incidence of multidrug resistant tuberculosis was 450,000 cases. Extensively drug resistant tuberculosis xdrtb is defined as tuberculosis caused by a mycobacterium tuberculosis strain that is resistant to at least rifampicin and isoniazid among the first. These drugs are used to treat all persons with tb disease. Multidrug resistant mdr tuberculosis tb is a threat to global tb control, as suboptimal and poorly tolerated treatment options have resulted in largely unfavourable outcomes for these patients. Progress in diagnosing multidrug resistant tuberculosis 20 march 2014 geneva almost half a million people fell ill with multidrug resistant tuberculosis mdrtb in 2012, yet less than one in 4 of these people was diagnosed, mainly due to a lack of. Multidrug resistant tuberculosis refers to tuberculosis with resistance to at least rifampicin and isoniazid. Multidrug resistant tuberculosis mdrtb is caused by the transmission of multidrug resistant mycobacterium tuberculosis strains in new cases, or by the selection of single drug resistant strains induced by previous treatment.
Dec 18, 2016 with an estimated 480 000 new cases developing every year,1 multidrug resistant tuberculosis is one of the greatest public health challenges worldwide. 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. Pdf multidrugresistant and extensively drugresistant. Nomenclature for drug resistant tuberculosis cases drug resistant tuberculosis multidrug resistant tuberculosis mdrtb rifampin resistant tuberculosis rrtb new definition as of may 2016 prexdrtb resistant to inh, rif, and either quinolone or a second line injectable but not both extensivelydrug resistant tuberculosis.
Resistance to tuberculosis tb drugs is a formidable obstacle to effective tb care and prevention globally. Some forms of tb are also resistant to secondline medications, and are called extensively drug resistant tb. The ideal number of drugs needed and treatment duration are crucial issues in the management of multidrugresistant tuberculosis mdrtb. Multidrug resistant tuberculosis mdrtb, defined as disease caused by strains of mycobacterium tuberculosis resistant to at least isoniazid and rifampicin, threatens to erode progress in the global control of tb 1. Globalization and the spread of multidrug resistant tuberculosis. Tb usually affects the lungs, but it can also affect other parts of the body, such as the brain, the kidneys, or the spine. International policy for treatment of multidrug and rifampin resistant tuberculosis mdrrr tb relies largely on individual patient data ipd from observational studies of patients treated under routine conditions. Drugresistant tuberculosis curry international tuberculosis center.
A patient who develops active disease with a drug resistant tb strain can transmit this form of tb to other individuals. Citc is a project of the university of california, san francisco, funded by the centers for. The number of mdr tb cases in the uk has risen over the last 15 years, with ever more complex clinical cases and associated challenging public health and societal implications. In 2017, an estimated 558 000 new cases of mdrrrtb. Who treatment guidelines for drugresistant tuberculosis, 2016 update. Multi drug resistant tuberculosis treatment there are two types of such resistant tb infections. Pdf the diarylquinoline tmc207 for multidrugresistant. All rights, including translation into other languages, reserved. Multidrug resistant tuberculosis mdr tb is a significant threat to global health estimated to account for nearly half a million new cases and over 200,000 deaths in 20. Multidrugresistant tuberculosis is a form of tuberculosis infection caused by bacteria that are resistant to treatment with at least two of the most powerful firstline antitb medications, isoniazid and rifampin. Pdf rapid indication of multidrugresistant tuberculosis. In highincome lowtbincidence countries, a disproportionate number of mdrtb cases occur in migrant foreignborn populations, with concerns about low adherence rates in these patients compared to the host nonmigrant population. Multi drug resistant tuberculosis mdrtb is a contagious disease, which spreads as a droplet infection. Multidrugresistant tuberculosis mdrtb world health organization.
Levels are much higher in those previously treated about 20%. Multiple drug resistance mdr, multidrug resistance or multiresistance is antimicrobial resistance shown by a species of microorganism to multiple antimicrobial drugs. We commend the collaborative group for the metaanalysis of individual patient data in mdrtb treatment20171 on their important findings but have questions about the analyses. Multidrug resistant and extensively drug resistant tuberculosis.
The document includes recommendations on the treatment of multidrug resistant tb mdrtb as well as isoniazid resistant. The world health organization who developed the stop tb strategy and guidelines on how to prevent, control and treat mdrtb by using available data worldwide. In this study in south africa, a new agent, pretomanid, was combined with bedaquiline and linezo. Multidrugresistant tuberculosis mdrtb resistance to at least isoniazid and rifampicin will. 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. Standardised shorter regimens versus individualised longer. This indicates that the widespread use of a new drug may lead to the emergence. Apr 18, 2020 drug resistance in mycobacterium tuberculosis arises from the manmade selection of mutants that result from spontaneous chromosomal alterations. Multidrug resistant mycobacterium tuberculosis strains are threatening tb control in the world. Bedaquiline in the treatment of multidrug and extensively. Multi drug resistant tuberculosis mdrtb is defined as resistance to at least inh and rifampin, the two most powerful antitb agents and the basis of shortcourse chemotherapy regimens used in dot programs. No part of this publication may be reproduced in print, by photo static means or in any other manner, or stored in a retrieval system, or transmitted in any form. Tb experts should be consulted in the treatment of mdr tb. Extensively drug resistant tb xdr tb extensively drug resistant tb xdr tb is a rare.
Regimens without an injectable agent are considered not to have an intensive phase. Management of multidrugresistant tuberculosis mdrtb and extensively drug resistant tuberculosis has never. Mdrtb is defined as resistance to isoniazid and rifampin, which are the 2 most effective firstline drugs for tb. Multi drug resistant tuberculosis is defined as resistance to isoniazid and rifampicin whether there is resistance to other drugs or not. Undetected and improperly treated cases of tuberculosis resulting from ineffective tb management are major reasons for the spread of the disease and the development of mdrtb. In practice resistance to isoniazid and streptomycin only is probably the commonest form of resistance worldwide to more than one drug. Diabetes mellitus dm is an increasingly recognized comorbidity that can both accelerate tb disease and complicate its treatment. The latest antitb drug resistance surveillance data show that. Drug resistant tuberculosis tb has emerged as a significant global epidemic and poses a serious threat to hivinfected persons. Multidrug resistance severely limits available treatment options. Multidrug resistant tuberculosis is much more common in patients who have previously been treated for tuberculosis,1 and public health efforts have typically focused on highquality treatment of drug susceptible tuberculosis to prevent. We understand that individuals not given the drug under study were matched multiple times by propensity scoring to individuals to whom the drug was given. As india aims to end tuberculosis tb by 2025, increased prevalence of multi drug resistant mdr strains continues to be a major public health concern.
Multiple drug resistant tuberculosis mdrtb and xdrtb. Companion handbook to the who guidelines for the programmatic management of drug resistant tuberculosis. Multidrug resistant tb mdr tb is caused by tb bacteria that is resistant to at least isoniazid and rifampin, the two most potent tb drugs. Multidrugresistant tuberculosis mdrtb is tuberculosis due to organisms which show highlevel resistance to both isoniazid and rifampicin, with or without. Epidemiology and management of childhood multidrug. National action plan for combating multidrug resistant tuberculosis. Epidemiology of primary multidrugresistant tuberculosis. Multidrugresistant tuberculosis mdrtb oxford academic journals. Multidrugresistant tuberculosis and extensively drugresistant. Lashley, rn, phd, faan, facmg professor, college of nursing, and interim director, nursing center for bioterrorism and infectious disease preparedness, college of nursing rutgers, the state university of new jersey this module is designed to highlight important information about multidrug resistant tuberculosis mdrtb.
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. Multidrugresistant tuberculosis pubmed central pmc. Multidrugresistant tuberculosis treatment adherence in. Multidrugresistant tuberculosis course wma the world. Treatment of highly drugresistant pulmonary tuberculosis.
Ucsf this guide from the california department of public health and curry international tb center contains information and userfriendly tools and templates for the management of patients with drug resistant tb. Multidrug resistant tuberculosis treatment there are two types of such resistant tb infections. The purpose of this study was to establish a baseline for measuring the impact of the programmatic management of drug resistant tb program by following up on outcomes of all patients diagnosed with multidrug resistant tuberculosis in zambia between 2012 and 2014. Treatment of drug resistant tb treatment options for highly drug resistant tuberculosis are limited. These actions will contribute to the prevention of further resistance to tb drugs and significantly reduce the global spread of mdrtb.
Identifying inadequate therapy as the main cause of this form of the disease and explaining the factors leading to its occurrence, numerous social determinants that affect the risk of developing resistance are highlighted. Multi drug resistant tuberculosis is considered to be a worldwide problem with notoriously difficult and challenging treatment. Special article multidrug resistant tuberculosis recommendations for reducing risk during travel for healthcare and humanitarian work barbara j. Risk factors for multidrugresistant tuberculosis among. Multidrug resistant mdr tuberculosis tb represents tb which is simultaneous resistant to at least rifampicin r and isoniazid h.
Multidrugresistant tb mdr tb is caused by an organism that is resistant to at least isoniazid and rifampin, the two most potent tb drugs. Multidrug resistant tuberculosis mdrtb is defined as resistance to at least inh and rifampin, the two most powerful antitb agents and the basis of shortcourse chemotherapy regimens used in dot programs. Molecular studies of the mechanism of action of antitubercular drugs have elucidated the genetic basis of drug resistance in. The frequency of mdrtb varies substantially between countries. Almost one in four people in the world are infected with tb bacteria. The ideal number of drugs needed and treatment duration are crucial issues in the management of multidrug resistant tuberculosis mdrtb. Adverse drug reaction in treatment of multidrug resistant. Who treatment guidelines for drug resistant tuberculosis. In 2006, there were an estimated 489,000 new cases of multidrug resistant mdr tbwhich is tb that is resistant to at least isoniazid and rifampinand 116,000 estimated deaths. National action plan for combating multidrug resistant tuberculosis, year one report pdf, 6.
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 drug resistant tuberculosis drtb. Multidrug resistant tuberculosis course multidrug resistant tuberculosis mdrtb is difficult to treat and there exists a significant lack of information about this infectious disease. 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. Pdf prevalence of multidrug resistant tuberculosis among.
Sources of multidrug resistance in patients with previous. Extensively drug resistant tb xdr tb extensively drug resistant tb xdr tb is a rare type of mdr tb that is resistant to isoniazid and rifampin, plus any fluoroquinolone and at least one of three injectable secondline drugs i. Who consolidated guidelines on drugresistant tuberculosis. Multidrug resistant strains of mycobacterium tuberculosis seriously threaten tuberculosis tb control and prevention efforts. A policy framework on decentralised and deinstitutionalised management for south africa will continue to guide provinces in the complex process of decentralisation of drug resistant tb care and treatment. Tuberculosis is caused by infection with the bacteria mycobacterium tuberculosis. Pdf pdf icon 37k multidrugresistant tuberculosis mdr tb what is tuberculosis tb.
The growing crisis of multidrugresistant tuberculosis mdrtb is so serious that tuberculosis specialists have called it a time bomb,1 and multiple deadly explosions have already been reported globally. Adverse drug reaction adr associated with second line drugs can have severe impact on adherence to treatment. To ensure that adequate resources are allocated to prevent the emergence and spread of drug resistance it is. To understand the effect of drug resistant tb and better plan for treatment needs, somalias national tuberculosis control program directly measured drug resistance prevalence among a representative sample of tb. The molecular basis of resistance to isoniazid and rifampicin and some other drugs is now largely understood table 1.
Multidrug resistant mdr tuberculosis minnesota dept. Cases of multidrug resistant tuberculosis mdrtb appeared after the widespread use of rifampicin from the 1970s onward. Outbreak of multidrugresistant tuberculosis on daru island. Multidrugresistant tuberculosis and culture conversion. Drug resistance may worsen further with the emergence of resistance. 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. Association between diabetes mellitus and multidrug. Multidrug 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.
More recently the emergence of extensively drug resistant tb xdrtb has added to. We hope it will receive due consideration and support among. Shortcourse treatment for multidrugresistant tuberculosis. Multidrug resistant tuberculosis mdrtb 2018 update global burden the latest antitb drug resistance surveillance data show that 3. Thus, we read with interest the article by the collaborative group for the metaanalysis of individual patient data in mdrtb treatment2017,1 the results of which support our proposal,2 from 2015, to classify anti tuberculosis drugs on the basis of. Multidrug and extensively drug resistant tb mxdrtb. Rapid diagnosis of resistance is essential for adequate treatment and optimal control of the disease. In 2006, an international survey found that 20% of m tuberculosis isolates were.
Tuberculosis tb is an infectious disease that can affect any organ in the body, although the vast majority of cases involve only the lungs. Guidelines for programmatic management of drug resistant tuberculosis. Programmes and principles in treatment of multi drug resistant tuberculosis. Some forms of tb are also resistant to secondline medications, and are called extensively drugresistant tb. We sought to compare the effectiveness of two world health organization whorecommended regimens for the treatment of rifampin or multidrug resistant rrmdr tuberculosis tb.
Outcomes of multidrugresistant tuberculosis in zambia. Socioeconomic factors contributing to multidrug resistant tuberculosis mdrtb saira zai1, tyaba haroon1, khawaja tahir mehmood2 1department of pharmacy, lahore college for women university. National action plan for combating multidrugresistant. The united states will work domestically and internationally to contribute to the prevention, detection, and control of multidrug resistant tuberculosis in an effort to avert tuberculosis associated. Clinical implications of the global multidrugresistant. Multidrug resistant tuberculosis mdrtb has been reported in all regions of the world. Multidrugresistant tuberculosis mdrtbwho policy statement, 2008. Multi drug resistant tuberculosis mdrtb has emerged as a challenge to global tuberculosis tb control and remains a major public health concern in many countries. The last of six cohort studies conducted in bangladesh which assessed a new shorter regimen using currently available tb drugs showed promising results and offered the possibility of a more.