MDR-TB Treatment & Prevention

Possible reasons: a) undisclosed previous treatment history;
b) unsupervised category 1 treatment;
c) irregular intake of anti-TB drugs in the past as of (a).

Categorisation might have been incorrect when the patient was initially put on CAT I because the patient :1) Did not understand the importance of giving relevant drug history 2) Patient may have been unaware that he was taking ATD - especially quinolones which may have masked the symptoms 3) patient did not really recollect the number of times he has been put on long continued medicines - as the practice of changing antibiotics frequently is common with the practitioners 4) The medical officer might not have enough time to take a detailed history

Plans are being made so that right at the beginning the patient can be tested for drug resistance

Hope to see the sea change

Thanks


Dr. Shanta Ghatak
MDR TB Officer-India TB Project
PATH,2nd Floor,State Immunization complex,
Commissionerate of Family welfare,Sultanbazar,Koti,
Hyderabad 500095,Andhra Pradesh,India.
Mobile: +91 08008277383
Skype  : shantaghatak

In addition to information provided by others I would like to add that primary
resistance, though rare, is a known phenomenon. Certain percentage of new cases
may also have MDR-TB without any previous history of treatment. In case of
Bangladesh, it is estimated at 2.2% (ref: Multidrug and extensively
drug-resistant TB (M/XDR-TB): 2010 global report on surveillance and response.
WHO)

Thanks

Vineet Bhatia

Think also of tranmission of resistant strains, and do contact tracing to evaluate whether there is another case in the family. Activate the DRTB outbreak response.
Dr Francoise Nywagi Louis
URC Regional TBHIV Technical Advisor- Pretoria- RSA

In that case a drug resistance survey would give the definitive results for the entire area and this would help the treatment. The medical officers and relevant personnel should be aware about the DRS results.

Thanks and regards

Dr. Shanta Ghatak
MDR TB Officer-India TB Project
PATH,2nd Floor,State Immunization complex,
Commissionerate of Family welfare,Sultanbazar,Koti,
Hyderabad 500095,Andhra Pradesh,India.
Mobile: +91 08008277383
Skype  : shantaghatak

Dear Mustafizur Rahaman,

This looks like a primary MDR! However, my main concern is that since only around 300 to 400 MDR TB cases treated annually among estimated 15,000 MDR TB cases in Bangladesh. The remaining untreated/ unrecognized MDR TB cases continues to spread the MDR bacilli in the community which may leads to the increasing trends of MDR TB among new cases. In case, we fail to take adequate action at this stage we may face a huge burden of MDR TB among previously untreated new TB cases.

Dr. Salim
Senior TB Consultant
KNCV Tuberculosis Foundation

Patient could have a close contact with MDR TB. In our region more than 30% of new MDR TB cases are from family contact

Thank u all for giving such kind of good and logical informations.

with regards
Mostafizur Rahman

Reply-
Primary acquired MDR-TB case means who was never exposed to TB drugs in his
life before but diagnosed as MDR-TB(New Cases), and Secondary acquired MDR-TB
case means it has been acquired due to weak DOTS system,low quality
medicine,treatment gap with so many reasons.
Let me be clear that the sample was taken for diagnosis purposes or follow up to
define the case whether it is a primary DR-TB or secondary DR-TB?
Moreover, it would be a bit strange if all the first line drugs become
resistant at a time,if the case is new.
Also need to know the names of SL Drugs have been tested for DST? Otherwise
validation of the DST results is important.


Regards.

________________________________
Sarder Tanzir Hossain
B.Sc.(Hon's) and M.S. in Microbiology (DU)
Microbiologist, National TB Control Program,
Health Program, BRAC Afghanistan.
Website:http://www.brac.net,www.bracafg.org

If the past treatment history has been taken accurately and if DST was carried out at the laboratory whose proficiency has been validated by one of SRL, he or she has been infected with MDR organisms from other MDRTB patient and developed to MDRTB. This type of MDRTB is the primary MDRTB (not primary acquired MDRTB). If the patient has been treated with anti-TB drugs, but failed treatment and the organisms, MDR. If it was known that the patient organisms were susceptible to all drugs before treatment, it is genuine acquired MDRTB due to unsuccessful treatment. However, if pretreatment DST was not done, there is possiblity for this patient to have had primary MDRTB before treatment. That is why we recommend to use term "drug resistance (including MDR) of previously treated cases" instead of acquired drug resistance for the survey sample. Primary drug resistance also is not easy to verify because of uncertaintity of the past treatment history taken. So, we recommend to use the term "drug resistance of new patients" instead of the primary drug resistance especially in the drug resistance survey.
I hope it could be useful to clarify the terms of the primary and acquired drug resistance ...

If the past treatment history has been taken accurately and if DST was carried out at the laboratory whose proficiency has been validated by one of SRL, he or she has been infected with MDR organisms from other MDRTB patient and developed to MDRTB. This type of MDRTB is the primary MDRTB (not primary acquired MDRTB). If the patient has been treated with anti-TB drugs, but failed treatment and the organisms, MDR. If it was known that the patient organisms were susceptible to all drugs before treatment, it is genuine acquired MDRTB due to unsuccessful treatment. However, if pretreatment DST was not done, there is possiblity for this patient to have had primary MDRTB before treatment. That is why we recommend to use term "drug resistance (including MDR) of previously treated cases" instead of acquired drug resistance for the survey sample. Primary drug resistance also is not easy to verify because of uncertaintity of the past treatment history taken. So, we recommend to use the term "drug resistance of new patients" instead of the primary drug resistance especially in the drug resistance survey.
I hope it could be useful to clarify the terms of the primary and acquired drug resistance.

Regards

Sang Jae Kim, MPH, ScD
Director Emeritus
Korean Institute of Tuberculosis
Seoul, Korea

Your are absolutely right.I want to put the issue that is -to identify the
reactivation or reinfection of TB is very difficult.It needs genotyping. In
DR-TB survey ,is it so necessary to know about the genetic makeup of the strain
?I know it has some importance to understand from where the strain comes or
to see how many patients are infected with the same strain.May be to find the
primary MDR-TB through matching the strain

Apart from these reasons, are there any other reasons to do genotyping in
DR-TB survey that is related to MDR-TB treatment?

Regards,

________________________________
Sarder Tanzir Hossain
B.Sc.(Hon's) and M.S. in Microbiology (DU)
Microbiologist, National TB Control Program,
Health Program, BRAC Afghanistan.
Website:http://www.brac.net,www.bracafg.org

acquisition of drug resistance tuberculosis might be secondarily. these cases might come from arease where MDR TB is rampant. there might be usage of these first line anti TB drugs previously which they really dont not know as they collect drugs especially from private health facilities

Ismael Hassen

FMOH, ETHIOPIA