multi-drug resistant tuberculosis
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Epidemiology
- outbreaks of multi-drug resistant tuberculosis have occurred in urban populations at risk for TB & HIV
Laboratory
- DNA-based test MTBDRsl provides results in 24 to 48 hours detects mutations that make MDR-TB resistant to treatment[4]
Management
- empiric therapy should consist of 5-6 drugs
- treatment should consist of at least 3 drugs to which the organism is sensitive
- addition of linezolid may be of benefit[2]
- adverse effects common
- addition of bedaquiline (Sirturo) may be of benefit[3]
- consider surgery for which the bulk of the disease is resectable
- continue treatment for at least 18-24 months or for 12 months after culture negative
- associated with increased mortality[1]
- all infected contacts exposed to multidrug-resistant TB (MDR-TB) should be given a later-generation fluoroquinolone +/- a second drug[5]
* second line agents for treating multidrug-resistant tuberculosis
- streptomycin
- capreomycin
- ethionamide
- kanamycin or amikacin
- levofloxacin or moxifloxacin
- para-aminosalicylic acid
- bedaquiline[1]
More general terms
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Additional terms
References
- ↑ Jump up to: 1.0 1.1 1.2 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 16, 18. American College of Physicians, Philadelphia 1998, 2006, 2009, 2012, 2018
- ↑ Jump up to: 2.0 2.1 Lee M et al. Linezolid for treatment of chronic extensively drug-resistant tuberculosis. N Engl J Med 2012 Oct 18; 367:1508 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23075177
- ↑ Jump up to: 3.0 3.1 World Health Oragnization (WHO). 2013 The use of bedaquiline in the treatment of multidrug-resistant tuberculosis. Interim Policy Guideline. http://apps.who.int/iris/bitstream/10665/84879/1/9789241505482_eng.pdf
World Health Oragnization (WHO). 2013 WHO interim guidance on the use of bedaquiline to treat MDR-TB https://mail.google.com/mail/u/0/?shva=1#inbox/13f425db09d8dfc1 - ↑ Jump up to: 4.0 4.1 World Health Oragnization (WHO). May 12, 2016 Rapid diagnostic test and shorter, cheaper treatment signal new hope for multidrug-resistant tuberculosis patients. http://www.who.int/mediacentre/news/releases/2016/multidrug-resistant-tuberculosis/en/
- ↑ Jump up to: 5.0 5.1 Nahid Pm Mase SR, Migliori SB et al Treatment of Drug-Resistant Tuberculosis. An Official ATS/CDC/ERS/IDSA Clinical Practice Guideline. AM J Resp Crit Care. 200(10): Nov 15 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31729908 Free PMC Article https://www.atsjournals.org/doi/full/10.1164/rccm.201909-1874ST