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Identifying Cases of MDR-TB

Identifying Cases of MDR-TB. Session 3. Old WHO recommendations. New 2010 WHO recommendations.

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Identifying Cases of MDR-TB

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  1. Identifying Cases of MDR-TB Session 3

  2. Old WHO recommendations

  3. New 2010 WHO recommendations "To move towards universal access to MDR-TB treatment, the fourth edition includes a new recommendation for every country to include an MDR regimen in its standard regimens. This is essential while awaiting DST results for patients with a high likelihood of MDR (such as those whose prior treatment with a 6-month rifampicin regimen has failed), and for patients in whom resistance to isoniazid and rifampicin is confirmed." • World Health Organization (WHO). Treatment of Tuberculosis: Guidelines. Fourth Edition. Geneva: WHO, 2010.

  4. New WHO recommendations • "In settings where rapid molecular-based DST results are not routinely available to guide the management of individual patients, empiric treatment should be started as follows: • TB patients whose treatment has failed or other patient groups with high likelihood of multidrug-resistant TB (MDR) should be started on an empirical MDR regimen; • TB patients returning after defaulting or relapsing from their first treatment course may receive the retreatment regimen containing first-line drugs 2HRZES/1HRZE/5HRE if country-specific data show low or medium levels of MDR in these patients or if such data are not available."

  5. MDR-TB risk stratification if rapid DST is not available Medium Risk

  6. MDR-TB risk stratification if rapid DST is not available High Risk

  7. Household contacts of MDR-TB patients almost always have MDR-TB • A Peru study looked at 4503 household contacts of 693 MDR-TB and XDR-TB index patients: • 117 (2.6%) had active TB at the time the index patient began MDR-TB treatment • 242 contacts developed TB during 4-year follow-up • Of the 359 cases of active TB, 142 had DST, of whom 129 (91%) had MDR-TB Becerra MC, Appleton SC, Franke MF, et al. Tuberculosis burden in households of patients with multidrug-resistant and extensively drug-resistant tuberculosis: a retrospective cohort study. Lancet 2011; 377: 147-52.

  8. MDR-TB in Category I treatment failure • Becerra MC et al. Int J Tuberc Lung Dis. 2000; 4(2): 108-14. • Fitzwater SP et al. Clin Inf Dis 2010; 51(4):371–37. • Quy HT et al. Int J Tuberc Lung Dis 2003; 7: 631-636. • Gler MT et al. Int J Tuberc Lung Dis 2011; 15: 652-656.

  9. When to suspect MDR-TB? Chavez AM, Blank R, Smith Fawzi MC, et al. Identifying early treatment failure on Category I therapy for pulmonary tuberculosis in Lima Ciudad, Peru. Int J Tuberc Lung Dis 2004; 8: 52-8.

  10. Early identification and prompt treatment of DR-TB • Prevents the spread of disease, • Helps stop development of further amplification of resistance, • Reduces the progression to permanent lung damage, and • Results in higher cure rates.

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