n CME : Your SA Journal of CPD - Multidrug-resistant tuberculosis : main topic




Multidrug-resistant TB (MDR-TB) is an emerging threat to TB control. <br>Although patient non-adherence is often thought to be the most common cause of drug resistance, many studies have shown that organisational failure of TB control programmes, lack of available drugs, and clinical error are responsible for much of the MDR-TB problem existing today. <br>Although the term MDR-TB has been used to describe resistance to any two or more anti-TB drugs, the correct definition is resistance to at least isoniazid and rifampicin. <br>MDR-TB rates in Africa are among the lowest recorded globally, being ascribed to the late introduction of rifampicin and its limited use in TB control programmes. <br>A recent national survey by the Medical Research Council indicated an overall MDR-TB prevalence of 2.9%, arising from 1.6% of new TB cases and 6.6% of previously treated cases. <br>MDR-TB should be suspected in patients with persistently positive acid-fast bacilli (AFB) smears or cultures despite adequate treatment adherence. <br>Clinical presentation of patients with MDR-TB is identical to that of patients with drug-susceptible disease, and radiological features are indistinguishable. <br>Treatment of MDR-TB involves second-line, reserve drugs that are much more expensive, more toxic and less effective than first-line TB drugs. <br>Design of MDR-TB regimens poses several challenges, complicated by a limited choice of second-line agents. <br>The use of multiple drugs is imperative to avoid amplification of resistance. <br>Treatment must be given under direct observation on at least 5 days a week. Patients must receive a minimum of 16 months' treatment (4 months of intensive and at least 12 months of continuation phase therapy, based on culture conversion) and must complete the full course. Short interruptions of treatment must be corrected by adding the number of drug doses missed. <br>AU MDR-TB patients with HIV co-infection should receive antiretroviral treatment, irrespective of CD4 count.


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