Microteaching

MDR -TB

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 Learning objectives
At the end of session, audience should be able to understand
and answer following questions related to MDR-TB:-

 Recent change in treatment guidelines of TB

 What is MDR -TB, its causes and population at risk?

 Prevalence of MDR-TB, treatment and its prevention

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 Tuberculosis
 Tuberculosis is a specific
infectious disease caused by M.
tuberculosis .

 The disease primarily affects

lungs and causes pulmonary
tuberculosis .

 It can also affect intestine ,

menninges , bones and joints ,
lymph glands , skin and other
tissues of the body.

 Pulmonary tuberculosis , the most

important form of tuberculosis .

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New guidelines 2016 – daily regime

Daily medicine dosing according to four weight

bands (25-39 kg/40-45kg/55-69kg/>70 kg) .

Fixed drug combination (single tablet contains all 4

drugs).

HRE in continuation phase not ( HR).

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 Treatment categories

n Cat1- New patients:-

Intensive phase -2 HRZE/ Continuation phase – 4 HRE

n Cat 2 – Retreatment :-

IP- 2HRZES/ 1HRZE/CP- 5 HRE

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 Number of tablets to be consumed
Weight Intensive phase Continuation Injection
category phase streptomycin(g
m)
HRZE HRE
75/150/400/275 75/150/275 mg
mg per tablet per tablet

25-39 kg 2 2 0.50
40-45 kg 3 3 0.75
55-69 kg 4 4 1
>70 5 5 1
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 Multi-Drug resistant TB
 MDR TB does not
simply means resistance
to more than one drug, it
specifically means
resistance to at least both
isoniazid and rifampicin.

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 Causes

Multi –factorial:-
 Inadequate treatment
 Lack of adherence/ intermittent or interrupted therapy
 Malabsorption
 Inappropriate regimes; to properly treat TB one must
always add at least two drugs to a failing regimes
 Sub –therapeutic dosing
 Expired or substandard drugs.

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 Persons at increased risk for Drug
Resistance

 History of treatment with TB

drugs

 Contact of a person with drugs

resistant person

 Smear or culture remain positive

despite 2 months of TB
treatment.

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 MDR in India
 Incidence of TB – 167 per 100000 population

 Prevalence of TB – 195 per 100000 population

 TB death rate – 17 per 100000 population

 Among notified TB cases 5.3%

 Among newly diagnosed TB cases 2.2%

 Among the retreatment TB cases 15%

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 Indication for DST

 Drug susceptibility testing indicated for :-

 All retreatment cases prior to initiation of retreatment

 Any patient who does not respond to therapy

 Conduct culture and DST for patients who have positive

smears despite 2 months of therapy.

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 Consequences of MDR
 Delay in diagnosis

 Treatment duration extended 18-24 months

 Second line drugs

- Effectiveness decreases
- Toxicity increases

 Expensive to treat

 Community transmission
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 How can be prevent MDR TB
 Initial
treatment with standardized
regime (HRZE)

 Directly observed therapy (DOT)

 Drug susceptibility testing for all

retreatment cases

 Infection control precautions

 Monitor drug resistance through

surveys

 Effective contact management

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 The End TB strategy
 Vision:- A world free of TB Zero deaths, disease and
suffering due to TB .

 Goal :-End the global tuberculosis epidemic

 Indicators :-
 95% reduction by 2035 in number of TB deaths compared
with 2015
 90% reduction (< 10/100000)by 2035 in TB incidence rate
compared with 2015
 Zero TB affected families facing catastrophic costs due to
TB by 2035.
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