multi-drug resistant tuberculosis

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

Management

• empiric therapy should consist of 5-6 drugs
  • isoniazid (INH), rifampin, pyrazinamide, ethambutol, streptomycin, fluoroquinolone*
• treatment should consist of at least 3 drugs to which the organism is sensitive
• addition of linezolid may be of benefit
  • adverse effects common
• addition of bedaquiline (Sirturo) may be of benefit
• 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
• all infected contacts exposed to multidrug-resistant TB (MDR-TB) should be given a later-generation fluoroquinolone +/- a second drug

* second line agents for treating multidrug-resistant tuberculosis

• streptomycin
• capreomycin
• ethionamide
• kanamycin or amikacin
• levofloxacin or moxifloxacin
• para-aminosalicylic acid
• bedaquiline

More general terms

• drug-resistant tuberculosis

More specific terms

• extensively drug-resistant tuberculosis (XDR-TB)

Additional terms

• Mycobacterium tuberculosis (MTB)