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MULTIDRUG RESISTANT TB IN BOTSWANA (MDR-TB)

MULTIDRUG RESISTANT TB IN BOTSWANA (MDR-TB). By: Mpho Kontle and Topo Moses. Introduction & Etiology.

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MULTIDRUG RESISTANT TB IN BOTSWANA (MDR-TB)

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  1. MULTIDRUG RESISTANT TB IN BOTSWANA (MDR-TB) By: MphoKontle and Topo Moses

  2. Introduction & Etiology • Multi-drug-resistant tuberculosis (MDR-TB) is defined as tuberculosis that is resistant to at least isoniazid (INH) and rifampicin(RMP),the two most powerful first-line treatment anti-TB drugs. • MDR-TB develops during treatment of fully sensitive TB when the course of antibiotics is interrupted and the levels of drug in the body are insufficient to kill 100% of bacteria.

  3. Prevalence • Three studies performed to establish the level of drug resistance in Botswana indicate that drug-resistant TB is a growing problem. • The prevalence of MDR-TB was 0.4% among new TB cases and 6.1% in retreatment cases in a survey conducted from 1994-2004. • Rising to 0.8% and 12.3% respectively in 2006 and to 0.8% and 10.4% respectively in 2011. • These data represent slight but statistically significant increases.

  4. Causes • Microbial resistance due to genetic mutation of the bacilli. • Mostly man made due to • poor drug treatment adherence • Inappropriate drug prescription • Irregular drug supply and poor drug quality

  5. DIAGNOSIS • Through culture and sensitivity of sputum collected from suspected patients. • Provision of routine drug testing to susceptible individuals.

  6. Who is at risk? • Failure of first line regimen, sputum is positive after 5 months or later during treatment • Failure of re-treatment regimen and chronic TB cases, usually 80% of the cases. • Patients who remain sputum smear positive at 2-3 months during the course of treatment. • Residence in areas with high prevalence of MDR-TB • Exposure in Institutions that have MDR-TB outbreaks or high MDR-TB prevalence • History of taking poor quality anti TB drugs. • contact with MDR-TB case

  7. SYMPTOMS • Chest pains • Coughing blood • Weight loss • Fever • Feeling weakness • Night sweating

  8. TREATMENT • A standardised Category IV treatment regimen has been developed for Botswana that may be used until the DST results are available, as shown in Table below. • Usually about 6 different drugs are used to treat MDR-TB depending on its severity and concentration.

  9. Treatment

  10. Treatment Duration • The recommended duration of treatment is guided by culture conversion. • Treatment should continue for at least 18 months after culture conversion. • Extension to 24 months may be indicated in patients defined as “chronic cases” with extensive pulmonary damage

  11. Prevention • Prevention is always better than cure, hence highly emphasized by; • Invention of educational programmes in clinics to teach infected individuals proper sputum disposal. • Home-to-home health-based care provided by health personnel, especially to older/unable patients. • Affected family members are taught MDR-TB preventative measures for free.

  12. references • http://en.wikipedia.org/wiki/Multi-drug-resistant_tuberculosis • http://www.who.int/hiv/pub/guidelines/botswana_tb.pdf • http://www.who.int/tb/challenges/mdr/surveillance/en/index.html • http://www.cdc.gov/botusa/news/0308/page_02.html

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