Medically Verified By: Dr. Rajesh Vandra
Tuberculosis (TB) is a bacterial disease that spreads from person to person through various means. The primary organs affected by TB are the lungs, followed by kidneys, brain and spine. Usually, when TB is not properly treated, TB is curable and the patient dies in rare cases.
Multidrug-resistant tuberculosis (MDR-TB) is caused by a bacteria called mycobacteria, which is resistant to at least two of the most effective first-line TB medicines, i.e., isoniazid and rifampin. When bacteria develop resistance to specific TB medicines, it confirms that the drugs are no longer effective. Commonly, these medicines are used as a first-line treatment to treat people who have TB. Consequently, second-line medicines must be used to treat MDR-TB. Second-line treatment is more tedious, expensive, and challenging. Mycobacteria, such as other bacteria, can undergo genetic alterations (called mutations), making them inherently resistant to anti-TB drugs. Treatment therapy with three or four combination medicines can prevent resistant mycobacteria from proliferating and replacing sensitive mycobacteria that can be removed using standard TB treatment. If resistant mycobacteria develop medication resistance to the second-line treatment, the whole mycobacterial population might be replaced with mycobacteria that have mutated twice and are resistant to two lines of treatment. Resistant mycobacteria can be passed onto others, making them instantly resistant to standard TB therapy.[1-3]
MDR-TB has the same symptoms and affects the same organs as traditional TB; however, it lasts longer than traditional TB because the resistant mycobacteria are eliminated more slowly or not at all.
It spreads in the same manner as TB. Moreover, the symptoms are similar to those of ordinary TB and include:[2,4]
Usually, MDR-TB is the consequence of an individual’s mistake such as when someone does not complete their treatment course. Inappropriate medical prescriptions, use of poor quality anti-TB medications, treatment interruptions, absence of national TB control
programmes, lack of standardised protocols, ineffective supervision by healthcare providers, and failure to finish therapy are the primary causes of MDR-TB.[2]
TB is primarily caused when people do not complete the full course of TB medications as prescribed by their doctor. The bacterium spreads through the air; therefore, when a TB patient sneezes, coughs, sings, or speaks, germs from their saliva enter the air. When a typical individual breathes that air, the possibilities of contracting MDR-TB are extremely high. The following factors increase your chances of contracting MDR-TB:
To prevent MDR-TB from spreading, the most important aspect a person can do is take all of their medicines exactly as advised by the doctor. There should be no missed doses, and treatment should not be quickly terminated before the prescribed time period. If patients are experiencing problems in taking their medications, they should inform their doctor. Patients should consult their healthcare provider if they intend to travel. They should consult their doctors and ensure they have sufficient medicine to last them for the trip duration.
By quickly detecting cases, following approved treatment protocols, evaluating patients' responses to treatment, and ensuring that medication is finished; health care workers can help prevent MDR-TB.
Avoiding exposure to known MDR-TB patients in closed or congested areas such as hospitals, prisons, or homeless shelters is another approach to avoid contracting MDR TB. If you work in a hospital or other healthcare facility where TB patients are possibly seen, you should seek advice from infection control or occupational health professionals. Inquire about administrative and environmental measures for avoiding contamination. Moreover, additional precautions, such as using personal respiratory protection gear, could be used once those protocols are in place.[5]
The patient had previously received therapy for TB. The frequency of resistance in the community is ~4 per cent; there is a chance that patients will be exposed to MDR-TB.
Despite four months of typical short-course therapy, there is a poor response to medication treatment, as confirmed by extended fever or cough, as well as sputum conversion failure.
Drug susceptibility tests take ~10–12 weeks because mycobacteria slowly develop. Consequently, quick testing procedures are required to detect drug resistance early and appropriately treat it. Slide culture sensitivity approaches (detect drug resistance in approximately a week), phage-based method with the ‘luciferase integrated' BACTEC method is another diagnostic method. It is a radiometric technique based on the detection of radiolabelled CO2 as a measure of microorganism growth index.
Certain rapid testing approaches to detect drug resistance include genotypic procedures, including rapid genotypic analysis of mycobacteria to discover gene changes causing drug resistance. Currently, most laboratories are unable to use such rapid testing methods because of cost factors.[6]
Drug resistance may be suspected based on prior treatment history (e.g., smear-positive case after numerous treatment courses and Cat II failure) and/or close contact with a probable source case confirmed to have drug-resistant TB. If drug resistance is suspected in a patient, MDR-TB should be diagnosed with a culture and drug susceptibility test.[7]
Treatment for MDR-TB is less effective. Compared to treating traditional TB, the expense of treatment and incidence of side effects are both higher. The World Health Organization (WHO) has established important guidelines for treating drug-resistant TB.
WHO guidelines for the drug treatment of MDR-TB
It is not advisable to design a regimen for MDR-TB patients with the aim of maintaining medications in reserve. Placing the medications in reserve is pointless because treating MDR-TB with the finest available drugs is the patient’s only hope of survival.
In terms of drug selection, only those drugs should be administered that the patient has previously never received. Usually, this is because such medications are always toxic to bacilli.
At least three medications, preferably four or five, should be included in the initial regimen to combat MDR bacteria and again it should be kept in mind that drugs that the patient has never had before.
In terms of bactericidal activity, because the combination of an injectable aminoglycoside and pyrazinamide is synergistic, it is advantageous to include it among the medications selected to create the regimen. Because resistance to pyrazinamide is uncommon, pyrazinamide may be selected even if it has previously been used in the patient.
One or more medicines, particularly those that are toxic to the patient, may be removed after sputum conversion.
After the patient’s sputum is negative, MDR-TB medication should be continued for at least 18 months.
Moreover, the treatment should be performed on a daily basis and based on directly observed therapy (DOT).[6]
All first-line drugs to which the strain is still sensitive, a fluoroquinolone, an injectable drug, and one of many second-line drugs, such as ethionamide, linezolid, clofazimine, cycloserine or PAS (p-aminosalicylic acid), and pyrazinamide, are included in the recommended treatment. Bedaquiline and delamanid are two new medications that could be employed. Treatment can continue for up to two years and is frequently accompanied by various adverse effects, some of which are severe. MDR-TB can be a severe financial burden on national TB programmes, costing tens to hundreds of times more than standard TB therapy. If resources are scarce, this could jeopardise the care of other patients.[2]
References
The Health Ministry has introduced a provision for jail terms of up to two years if the major stakeholders in the fight against TB fail to report such cases to the nodal officer.
The 15-year-old girl from Nerul was experiencing discomfort for over 15 days.
The approval was granted by the Central Licencing Authority.
Important facts you must know about Multi Drug- Resistant TB.
India continues to have 24 per cent of the world's total Tuberculosis (TB) burden.
Lack of diagnostic tests, cost of treatment and not living a healthy life are few reasons why TB is still a cause of concern.
Did you know almost 10% of total TB cases in India are among children, but only 6% are reported?
While India has been engaged in tuberculosis control efforts for decades now, TB continues to remain one of our greatest public health challenges.
India accounts for an estimated 2.2 million of the 8.6 million new cases of TB that occur each year globally.
With multi-drug resistant tuberculosis emerging as a major obstacle in the fight against tuberculosis, doctors advocate the need for a collective move to adopt appropriate diagnostic mechanisms that help in an accurate diagnosis of drug-resistant strains of TB.
Over 600 patients from across the country will be treated for MDR TB with Bedaquiline in six public hospitals across the country.
It all began in 2005, when Lucy went to a clinic to confirm her 2nd pregnancy (she already had a 7 years old son). There she also took the HIV testing offered to her. She tested positive for both. The joy of being pregnant was completely overshadowed by her HIV positive status.
MDR-TB cases on the rise--all you should know about the deadly disease
Shah will present his research paper at the two-day World Homeopathy Summit organised by the Global Homeopathy Foundation from April 11 in Mumbai.
India still has a long way to go before it can address the TB menace that it faces thanks to
Mumbai might be on the brink of drug-resistant TB epidemic
This World Tuberculosis Day learn about the different diagnostic techniques to test for TB, MDR TB and XDR TB.
Here is an exclusive interview with Dr Kapil Salgia about the new line of treatment for patients with TB.
Satyamev Jayate season 3 episode 4: 5 things you didn't know about MDR TB
Satyamev Jayate Season 3 Episode 4: How TB is affecting India's health (Live Blog)
Aamir Khan explains how TB spreads in Bollywood style
Satyamev Jayate season 3 episode 4: 9 symptoms of TB
Unregulated diagnosis and non-qualified doctors to blame for drug-resistant TB spread
Find out everything you need to know about stem cell therapy.
The Health Ministry has introduced a provision for jail terms of up to two years if the major stakeholders in the fight against TB fail to report such cases to the nodal officer.
The 15-year-old girl from Nerul was experiencing discomfort for over 15 days.
The approval was granted by the Central Licencing Authority.
Important facts you must know about Multi Drug- Resistant TB.
India continues to have 24 per cent of the world's total Tuberculosis (TB) burden.
Lack of diagnostic tests, cost of treatment and not living a healthy life are few reasons why TB is still a cause of concern.
Did you know almost 10% of total TB cases in India are among children, but only 6% are reported?
While India has been engaged in tuberculosis control efforts for decades now, TB continues to remain one of our greatest public health challenges.
India accounts for an estimated 2.2 million of the 8.6 million new cases of TB that occur each year globally.
With multi-drug resistant tuberculosis emerging as a major obstacle in the fight against tuberculosis, doctors advocate the need for a collective move to adopt appropriate diagnostic mechanisms that help in an accurate diagnosis of drug-resistant strains of TB.
Over 600 patients from across the country will be treated for MDR TB with Bedaquiline in six public hospitals across the country.
It all began in 2005, when Lucy went to a clinic to confirm her 2nd pregnancy (she already had a 7 years old son). There she also took the HIV testing offered to her. She tested positive for both. The joy of being pregnant was completely overshadowed by her HIV positive status.
MDR-TB cases on the rise--all you should know about the deadly disease
Shah will present his research paper at the two-day World Homeopathy Summit organised by the Global Homeopathy Foundation from April 11 in Mumbai.
India still has a long way to go before it can address the TB menace that it faces thanks to
Mumbai might be on the brink of drug-resistant TB epidemic
This World Tuberculosis Day learn about the different diagnostic techniques to test for TB, MDR TB and XDR TB.
Here is an exclusive interview with Dr Kapil Salgia about the new line of treatment for patients with TB.
Satyamev Jayate season 3 episode 4: 5 things you didn't know about MDR TB
Satyamev Jayate Season 3 Episode 4: How TB is affecting India's health (Live Blog)
Aamir Khan explains how TB spreads in Bollywood style
Satyamev Jayate season 3 episode 4: 9 symptoms of TB
Unregulated diagnosis and non-qualified doctors to blame for drug-resistant TB spread
Find out everything you need to know about stem cell therapy.
