MDR-TB Treatment & Prevention

Thank you for your contribution. I think a patient who received Streptomycin, Rifampicin and one of the Quinolones for Brucellosis and later developed TB and has never had TB before should be considered as a new case of TB. The anti TB received for brucellosis is not a standard regimen combination for TB.
Thank you.

David

I will like to completely agree with David as the said regimen is not standard TB treatment as stated

i do agree with the contributions above.though i am curious about the previous drugs taking by the patient and it,s effect on the new therapy.

Based on the fact that most of the TB endemic areas also have poor diagnostic support, then this definition needs to be looked at carefully especially from a stand point that Rifampicin is the backbone of anti-TB treatment. Most cases of Brucellosis are also treated on an empiric basis considering that the clinical set up is mainly rural and with poor lab support. There may be need to push for redefinition of terminology to consider such setups.

Dear colleagues,
The principle reason for classifying patients to new and previously treated is their chance of being ill with a strain resistant to some of the first-line anti-TB medicines. In most settings, culture and DST are limited and molecular methods for diagnosis of resistance (e.g LPA) are not yet widely available. Therefore it is important to prioritize the patients who may have been exposed to anti-TB medicines to be screened for possible drug resistance. History of taking anti-TB medicines while being ill particularly in the case you mentioned (mono-therapy) for more than one month significantly increase the chance of natural selection of the resistant strain(s). Therefore it would be logic to classify these patients as previously treated. This way one would prioritise examining the strain for drug resistance and provide the patient with a stronger treatment regimen, based on resistance pattern if possible and if not at least treatment with five rather than four drugs in the intensive phase and three rather two drugs in the continuation phase and for a longer treatment length to decrease the risk of further amplification of resistance. It is getting increasingly more important for practitioners to have overview of drug susceptibility ...

Dear colleagues,
The principle reason for classifying patients to new and previously treated is their chance of being ill with a strain resistant to some of the first-line anti-TB medicines. In most settings, culture and DST are limited and molecular methods for diagnosis of resistance (e.g LPA) are not yet widely available. Therefore it is important to prioritize the patients who may have been exposed to anti-TB medicines to be screened for possible drug resistance. History of taking anti-TB medicines while being ill particularly in the case you mentioned (mono-therapy) for more than one month significantly increase the chance of natural selection of the resistant strain(s). Therefore it would be logic to classify these patients as previously treated. This way one would prioritise examining the strain for drug resistance and provide the patient with a stronger treatment regimen, based on resistance pattern if possible and if not at least treatment with five rather than four drugs in the intensive phase and three rather two drugs in the continuation phase and for a longer treatment length to decrease the risk of further amplification of resistance. It is getting increasingly more important for practitioners to have overview of drug susceptibility pattern of the strains their patients are ill with.