Tuberculosis
Summary
Tuberculosis (TB) is caused by Mycobacterium tuberculosis that most often affect the lungs.
Rifampicin resistance (RR): resistance to rifampicin detected using phenotypic or genotypic methods, with or without resistance to other anti-TB drugs. Multidrug resistance (MDR): resistance to at least both isoniazid and rifampicin. 1,2
Rifampicin resistance (RR): resistance to rifampicin detected using phenotypic or genotypic methods, with or without resistance to other anti-TB drugs. Multidrug resistance (MDR): resistance to at least both isoniazid and rifampicin. 1,2
Causes
Tuberculosis is caused by Mycobacterium tuberculosis. TB is spread from person to person through the air. When people with lung TB cough, sneeze or spit, they propel the TB germs into the air.
MDR-TB is multifactorial and fueled by improper treatment of patients, poor management of supply and quality of drugs, and airborne transmission of bacteria in public places. 1,2
MDR-TB is multifactorial and fueled by improper treatment of patients, poor management of supply and quality of drugs, and airborne transmission of bacteria in public places. 1,2
Symptions
When a person develops active TB (disease), the symptoms (cough, fever, night sweats, weight loss etc.) may be mild for many months. This can lead to delays in seeking care, and results in transmission of the bacteria to others. 1
Treatment
In MDR/RR-TB patients who have not been previously treated for more than one month with second-line medicines used in the shorter MDR regimen or in whom resistance to fluoroquinolones and second-line injectable agents has been excluded, a shorter MDR-TB regimen of 9–12 months may be used instead of the longer regimens(4~6 Am(Cm)-Mfx(Lfx)-Pto-Cfz-Z-Hhigh dose -E/ 5 Mfx(Lfx)-Cfz-Z-E).
In MDR/RR-TB patients on longer regimens, a total treatment duration of 18-20 months is suggested for most patients, and the duration may be modified according to the patient’s response to therapy. All three Group A agents(Levofloxacin OR Moxifloxacin, Bedaquiline, Linezolid) and at least one Group B agent(Clofazimine, Cycloserine OR Terizidone) should be included to ensure that treatment starts with at least four TB agents likely to be effective and that at least three agents are included for the rest of treatment after Bedaquiline is stopped. If only one or two Group A agents are used, both Group B agents are to be included. If the regimen cannot be composed with agents from Groups A and B alone, Group C agents(Ethambutol, Delamanid, Pyrazinamide, Imipenem-cilastatin OR Meropenem, Amikacin OR Streptomycin, Ethionamide OR Prothionamide, p-aminosalicylic acid) are added to complete it. 3
In MDR/RR-TB patients on longer regimens, a total treatment duration of 18-20 months is suggested for most patients, and the duration may be modified according to the patient’s response to therapy. All three Group A agents(Levofloxacin OR Moxifloxacin, Bedaquiline, Linezolid) and at least one Group B agent(Clofazimine, Cycloserine OR Terizidone) should be included to ensure that treatment starts with at least four TB agents likely to be effective and that at least three agents are included for the rest of treatment after Bedaquiline is stopped. If only one or two Group A agents are used, both Group B agents are to be included. If the regimen cannot be composed with agents from Groups A and B alone, Group C agents(Ethambutol, Delamanid, Pyrazinamide, Imipenem-cilastatin OR Meropenem, Amikacin OR Streptomycin, Ethionamide OR Prothionamide, p-aminosalicylic acid) are added to complete it. 3
- https://www.who.int/features/qa/08/en/
- https://www.who.int/tb/areas-of-work/drug-resistant-tb/types/en/
- WHO treatment guidelines for multidrug-and rifampicin-resistant tuberculosis, 2018 update
CP-89365 Approved date 2019-5-5