Professional Documents
Culture Documents
MDR TB
MDR TB
Tuberculosis
Hail M. Al-Abdely
Consultant, Infectious
Diseases, KFSH&RC
Presentation Outline
Definition
of MDR TB
Epidemiology of MDR TB
Genesis of MDR
Mechanism of resistance
Treatment
Chemoprophylaxis for MDR TB
exposure
Definition of MDR TB
1950s-1970s:
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World
Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or
boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.
Global Tuberculosis Control. WHO Report 2002. WHO/CDS/TB/2002.295
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World
Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or
boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.
Global Tuberculosis Control. WHO Report 2002. WHO/CDS/TB/2002.295
Epidemiology of MDR TB
Geographic region
272,906 (3.2)
882 (0.7)
Latin America
8508 (2.2)
Eastern Europe
17,269 (5.5)
15,014 (1.9)
25,199 (1.8)
Eastern Mediterranean
45,964 (7.9)
Southeast Asia
75,062 (2.5)
Western Pacific
85,008 (4.5)
Estonia
14.1
Latvia
9.0
China (non-DOTS)
7.7
China (DOTS)
2.8
Russia
6.0
India
3.4
Iran
5.8
Dominican
6.6
Ivory Cost
5.3
Dye et al. Global Burden of Multidrug-Resistant TB. JID 185(8), 2002
Morocco*
2.2
Oman*
0.8
Algeria
0.7
Egypt
5.6
Jordan
2.8
Kuwait
3.3
Lebanon
3.4
Saudi Arabia
3.0
Sudan
10.1
Syria
6.7
Yemen
12.4
* Surveyed
Genesis of MDR TB
Acquired drug
resistance
Transmission
Primary drug
resistance
Mechanism of Resistance
TB
specific drugs
RIF
Aminogycosides
Flouroquinolones
Mechanism of resistance
INH
Chromosomally mediated
Loss of catalase/peroxidase
Mutation in mycolic acid synthesis
Regulators of peroxide response
Mechanism of resistance
Rifampin
of mutations at Rifampin
Resistance Determining Region (RRDR)
Treatment of MDR TB
Factors
determining Success
Culture of MDR TB
Reliable susceptibility
Reliable history of previous drug
regimens
Program to assure delivery of prescribed
drugs (DOT)
Correct choice of modified treatment
regimen
Reliable follow up
New flouroquinolones
Gatifloxacin, Moxifloxacin, levofloxacin, sparfloxacin
Nitroimidazoles
related to metronidazole. May work better against latent
bacilli
Chemoprophylaxis
Determinants
of intervention
suppression
Low
Intermediate to high
High possibility
for disease
No
Yes
Confirmed R
to INH+RIF
Standard
recommendation
For non-MDR TB contacts
Consider Multidrug
prophylaxis