Who consolidated guidelines on drugresistant tuberculosis treatment. Summary of a joint workshop by the institute of medicine, the indian national science academy, and the indian council of medical research 2012. Emergence of new forms of totally drug resistant tuberculosis bacilli. A new report warns that some of the incremental progress made in the global fight against tuberculosis tb could be lost with the emergence and.
These actions will contribute to the prevention of further resistance to tb drugs and significantly reduce the global spread of mdrtb. We evaluated the safety and efficacy of the drug combination for 26 weeks in patients with extensively drug resistant tuberculosis and patients with multidrug resistant tuberculosis that was not. In this regard, the who consolidated guidelines on drug resistant tuberculosis treatment fulfil the mandate of who to inform health professionals in member states on how to improve treatment and care for patients with drtb. Emergence of new forms of totally drugresistant tuberculosis bacilli. Tuberculosis, drugresistance, risk, diabetes, portugal 1. More important are the differences from the 2019 who consolidated guidelines on drugresistant tuberculosis treatment particularly the recommendation to initiate five drugs for the treatment of drugresistant tuberculosis in the current guidelines versus four drugs in the who guidelines. Pulmonary tuberculosis misdiagnosed as extensively drug. Drugresistant tuberculosis is a major public health concern in many countries. More recently the emergence of extensively drug resistant tb xdrtb has added to. Tuberculosis tb is a serious public health problem worldwide.
Globally the proportion of tuberculosis cases caused by drugresistant strains is increasing. Many of the drugs used to treat drugresistant tb are not food and drug administration fdalicensed for these indications. Drug resistant tuberculosis an overview sciencedirect. Pdf multidrugresistant tuberculosis mdrtb is an increasing global problem, with most cases arising from a mixture of physician error and patient.
The injectable drugs can cause hearing loss and balance problems. A patient who develops active disease with a drug resistant tb strain can transmit this form of tb to other individuals. Drugresistant tuberculosis the global fund to fight. Provider perspectives of the introduction and implementation. Apr 12, 2017 emergence of extensively drug resistant tuberculosis. Over the past decade, the number of patients infected with mycobacterium tuberculosis resistant to the most effective drugs against tuberculosis ie, rifampicin and isoniazid, which is called multidrugresistant tuberculosis, has continued to increase. The document includes recommendations on the treatment of multidrugresistant tb mdrtb as well as isoniazidresistant. The treatment of tuberculosis must take into account the possibility of drug resistance and include at least 2 drugs. In 2017, the who estimated that 558,000 people developed tb which was resistant to the most effective firstline tb drug rifampicin, and there were 230,000 associated deaths. Interruptions in the drug supply, improper drug prescription and nonadherence to treatment protocols promote drug resistance through mechanisms that are now well understood. Facing rising numbers of drtb patients, south africa sa introduced a decentralised model of care for drtb in 2011.
Several studies have demonstrated worse clinical outcomes in patients diagnosed with drugresistant tb 1. We evaluated the safety and efficacy of the drug combination for 26 weeks in patients with extensively drugresistant tuberculosis and patients with multidrugresistant tuberculosis that was not. Tuberculosis tuberculosis tuberculosis is the most common cause of morbidity and mortality in people living with hiv. We hope it will receive due consideration and support among all the provincial representatives and health care. The medications used for drug resistant tuberculosis include the injectable antibiotics capreomycin, kanamycin, and amikacin. Mdr tuberculosis and formulation of novel drugs, a great concern, when considering the increasing rates of mdr and extremely drug resistant xdr tb worldwide. Who treatment guidelines for drugresistant tuberculosis, 2016 update. Extensively drugresistant tuberculosis xdrtb appeared following the misuse of secondline drugs.
Tuberculosis itself is a bacterial infection caused by mycobacterium tuberculosis. The purpose of this study was to establish a baseline for measuring the impact of the programmatic management of drugresistant tb program by following up on outcomes of all patients diagnosed with multidrugresistant tuberculosis in zambia between 2012 and 2014. Cases of multidrugresistant tuberculosis mdrtb appeared after the widespread use of rifampicin from the 1970s onward. Its situation is worsened by the presence of multidrug resistant mdr strains of mycobacterium tuberculosis, the causative agent of the disease. In 2009, we proposed the term totally drugresistant tuberculosis tdrtb for tb strains that showed invitro resistance to all first and second line drugs tested isoniazid, rifampicin, streptomycin, ethambutol, pyrazinamide, ethionamide, paraaminosalicylic acid, cycloserine, ofloxacin, amikacin, ciprofloxacin, capreomycin, kanamycin. As of oct 2006, extensively drug resistant tuberculosis xdrtb is defined as mdrtb that is resistant to quinolones and also to any one of kanamycin, capreomycin, or amikacin. Tb, multidrug resistant tb mdr tb, or extensively drug resistant tb xdr tb, mycobacterium tuberculosis m. 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. A person with drug resistant tb should be treated by a specialist with considerable experience in managing the disease. National action plan for combating multidrugresistant tuberculosis. 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.
Drug resistant tuberculosis is a major public health concern in many countries. Drug resistant tuberculosis florida department of health. We aimed to document the introduction and implementation of the new models of care for patients with drtb in four provinces northern cape, kwazulunatal. Multidrugresistant tuberculosis mdrtb is tuberculosis due to organisms which show highlevel resistance to both isoniazid and rifampicin, with or without. Resistance to antituberculous agents can be either primary, that is, present before initiating therapy and due to transmission of a drug resistant m. 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. Drugresistant tuberculosis drtb is a major global public health problem. Provisional cdc guidelines for the use and safety monitoring of bedaquiline fumarate sirturo for the treatment of multidrug resistant tuberculosis. Outcomes of multidrugresistant tuberculosis in zambia. We examined outcomes and safety in those who received a. 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. Pfyffer,e sonia borrell,f,g olivier dubuis,h thomas bruderer,i hans h.
Drug resistant tuberculosis toxic side effects from tb treatment dr. The pico population, intervention, comparator and outcomes. Drugresistant tuberculosis toxic side effects from tb treatment dr. Though lungs are usually the prey of the disease but the bacterium can often attack spine, brain, and kidneys. Multidrugresistant 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. We prospectively followed up 122 south african patients 52. The reason for this inh resistance is not quite clear. 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. Despite success in tuberculosis control, multi drug resistant tuberculosis in bangladesh is increasing and currently multi drug resistant tuberculosis rate is 3. Multidrugresistant tb mdr tb is caused by an organism that is resistant to at least isoniazid and rifampin, the two most potent tb drugs. Summaries of unpublished data used for the recommendations 1. Abstract background patients with highly drugresistant forms of tuberculosis have limited treatment options and historically have had poor outcomes. The purpose of the present study was to determine the prevalence and detection of drug resistant mutations in m. Guidelines for clinical and operational management of drugresistant tuberculosis.
Drugresistant tuberculosis poses an immense challenge for tuberculosis control. Between 2011 and 2018, who has developed and issued evidencebased policy recommendations on the treatment and care of. 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. The term introduced first in 2005 but became popularly known as such when a survey study found that in rural south africa a large portion of patients with mdrtb had extensive drug resistance. 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. 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. This means that the drug can no longer kill the tb bacteria. National action plan for combating multidrug resistant tuberculosis. As of oct 2006, extensively drugresistant tuberculosis xdrtb is defined as mdrtb that is resistant to quinolones and also to any one of kanamycin, capreomycin, or amikacin. We aimed to document the introduction and implementation of the new models of care for patients with drtb in four provinces northern cape. 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. 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. The medications used for drugresistant tuberculosis include the injectable antibiotics capreomycin, kanamycin, and amikacin.
Pdf risk factors of multidrugresistant tuberculosis in. 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. Jul 02, 2014 however, even more disturbing is the emergence of drug resistance. Multidrugresistant tuberculosis and extensively drugresistant. Drugresistant tuberculosis drtb drugsensitive and drugresistant tuberculosis chapter 7. Tb is spread through the air from one person to another. Despite success in tuberculosis control, multidrug resistant tuberculosis in bangladesh is increasing and currently multidrugresistant tuberculosis rate is 3. Over the past decade, the number of patients infected with mycobacterium tuberculosis resistant to the most effective drugs against tuberculosis ie, rifampicin and isoniazid, which is called multidrug resistant tuberculosis, has continued to increase. Drugresistant tuberculosis curry international tuberculosis center. Siegrist,j hansjakob furrer,k alexandra calmy,l jan fehr,m jesica mazza stalder,n beatrice ninet,o erik c.
Essentially, drug resistance arises in areas with weak tb control programmes. Facing the reality of drugresistant tuberculosis in india challenges and potential solutions. Mdrtb is caused by strains of mycobacterium tuberculosis that are. Drugresistant tb is part of the growing challenge of antimicrobialresistant superbugs that do not respond to existing medications. 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. Tuberculosis, drug resistance, risk, diabetes, portugal 1. There are limited data on combining delamanid and bedaquiline in drug resistant tuberculosis drtb regimens.
Drugresistant tb dr tb is spread the same way that drugsusceptible tb is spread. Multidrugresistant tuberculosis mdrtb oxford academic journals. It is resistant to almost all drugs used to treat tb, including the two best firstline drugs. A person with drugresistant tb should be treated by a specialist with considerable experience in managing the disease. Prevalence and detection of drug resistant mutations in. Introduction drugresistant tuberculosis tb is a worldwide threat and constitutes an unparalleled challenge for disease con trol. More recently the emergence of extensively drugresistant tb. Drug resistant tuberculosis poses an immense challenge for tuberculosis control. Effect of mutation and genetic background on drug resistance in mycobacterium tuberculosis lukas fenner, amatthias egger, thomas bodmer,b ekkehardt altpeter,c marcel zwahlen,a katia jaton,d gaby e. Apr 12, 20 in 2009, we proposed the term totally drugresistant tuberculosis tdrtb for tb strains that showed invitro resistance to all first and second line drugs tested isoniazid, rifampicin, streptomycin, ethambutol, pyrazinamide, ethionamide, paraaminosalicylic acid, cycloserine, ofloxacin, amikacin, ciprofloxacin, capreomycin, kanamycin. It is caused by the organism mycobacterium tuberculosis mtb, which. Since 2006, it has been recognized the presence of even more resistant strains of m. Resistance to antituberculous agents can be either primary, that is, present before initiating therapy and due to transmission of a drugresistant m. Guidelines for the treatment of drugresistant tuberculosis.
A convenience sample of 309 drugsusceptible and 342 multidrugresistant mdr tb isolates, collected july 2008july 2009, were characterized by spoligotyping, dna fingerprinting, insertion site mapping, and targeted dna sequencing. Management of multidrugresistant tuberculosis mdrtb and extensively drug resistant tuberculosis has never. The tb bacteria are put into the air when a person with tb disease of the lungs or throat coughs, sneezes, speaks, or sings. Mar 23, 2017 a new report warns that some of the incremental progress made in the global fight against tuberculosis tb could be lost with the emergence and spread of drug resistant strains of the disease. 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. Introduction drug resistant tuberculosis tb is a worldwide threat and constitutes an unparalleled challenge for disease con trol. Extensively drug resistant tuberculosis xdrtb appeared following the misuse of secondline drugs. Extensively drugresistant tb xdr tb extensively drugresistant 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. Drugresistant tb has become a very serious problem in recent years in certain populations.
The ideal number of drugs needed and treatment duration are crucial issues in the management of multidrugresistant tuberculosis mdrtb. 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. Drug resistance mechanisms in mycobacterium tuberculosis. Multidrugresistant tuberculosis mdrtb is defined as tuberculosis tb disease where there is in vitro resistance to both isoniazid and rifampicin, with or without resistance to other antituberculosis drugs. Management of drugresistant tuberculosis the lancet. A patient who develops active disease with a drugresistant tb strain can transmit this form of tb to other individuals. Editor international union against tuberculosis and lung disease the union 68 boulevard st michel, 75006 paris, france suggested citation caminero ja, ed. In 2012, there were an estimated 450,000 cases of multidrug resistant mdrtb and 170,000 deaths were due to it. 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 treatment options and increasing mortality rates for illnesses that would ordinarily be curable including tb. A regimen containing bedaquiline and delamanid compared to.
There are limited data on combining delamanid and bedaquiline in drugresistant tuberculosis drtb regimens. Who consolidated guidelines on drugresistant tuberculosis. Xdr tb is also resistant to the best secondline medications. What is the treatment for drugresistant tuberculosis.
Objectives drug resistant tuberculosis drtb is a growing concern in many lowincome and middleincome countries. Many of the drugs used to treat drug resistant tb are not food and drug administration fdalicensed for these indications. The incidence of drug resistant tb has increased since the introduction of streptomycin, the first anti tuberculosis drug. Drug resistant tuberculosis is a severe form of tuberculosis disease which is untreatable through regular measures due to its nature. The old case definition of xdrtb is mdrtb that is also resistant to three or more of the six classes of secondline drugs. The sentinel project on pediatric drugresistant tuberculosis has recommended that children.
Factors driving the increase in drugresistant tuberculosis tb in the eastern cape province, south africa, are not understood. Multidrugresistant tuberculosis mdrtbwho policy statement, 2008. The incidence of drugresistant tb has increased since the introduction of streptomycin, the first antituberculosis drug. Mdr tuberculosis and formulation of novel drugs, a great concern, when considering the increasing rates of mdr and extremely drugresistant xdr tb worldwide. Facing the reality of drugresistant tuberculosis in india. Drug resistant tuberculosis an overview sciencedirect topics. Who treatment guidelines for drug resistant tuberculosis. Guidelines for clinical and operational management of drug. Treatment of drug resistant tb treatment options for highly drug resistant tuberculosis are limited. Sometimes drugresistant tb occurs when bacteria become resistant to the drugs used to treat tb. For example, tb resistant to the drug isoniazid inh is seen among patients from southeast asia. Patients who are infected with strains resistant to isoniazid and rifampicin, called multidrugresistant mdr tb, are practically incurable by standard firstline.
Drug resistant tb has become a very serious problem in recent years in certain populations. Tuberculosis that does not respond to standard drug treatment. Citc is a project of the university of california, san francisco, funded by the centers for. Prospective longterm outcome data, including in hivinfected persons, are unavailable. Cases of multidrug resistant tuberculosis mdrtb appeared after the widespread use of rifampicin from the 1970s onward. Multidrug resistant tuberculosis mdrtb can be defined as a strain resistant to at least isoniazid inh and rifampicin rfp, while extensively drug resistant tuberculosis xdrtb is a form of mdrtb with additional resistance to any fluoroquinolone and at least one injectable secondline drug i. In recent years, even more serious forms of drug resistance have been reported. Report warns of rise in drugresistant tuberculosis cidrap. Treatment of drugresistant tb treatment options for highly drugresistant tuberculosis are limited.
153 773 1034 111 1384 808 120 402 236 16 1126 1053 101 842 1102 73 285 278 893 217 45 1492 106 187 553 375 1159 978 545 883 678