Provisional cdc guidelines for the use and safety monitoring of bedaquiline fumarate sirturo for the treatment of multidrug resistant tuberculosis. Multidrugresistant mdr and extensively drugresistant tuberculosis xdrtb still represent a challenge for clinicians and staff. Guidelines for the management of multidrugresistant. Who treatment guidelines for drug resistant tuberculosis. International policy for treatment of multidrug and rifampinresistant tuberculosis mdrrr tb relies largely on individual patient data ipd from observational studies of patients treated under routine conditions. Tb care also implies deinstitutionalisation of care and treatment of patients. Mdr tb multidrug resistant tuberculosis mdrrr tb multidrugrifampicin resistant tuberculosis. Centers for disease control and prevention, european respiratory society, and infectious diseases society of america jointly sponsored this new practice guideline on the treatment of drugresistant tuberculosis drtb. Among drugresistant tb, multidrugresistant mdrtb denotes disease with bacillary resistance to at least isoniazid inh and rifampicin rif, the two most important firstline antitb drugs. Multidrugresistant tb mdrtb is tb that does not respond to at least isoniazid and rifampicin, the 2 most powerful antitb drugs.
Interim treatment outcomes at 6months for multidrugresistant tuberculosis mdrtb treatment are among the most basic performance monitoring and key evaluation indicators in the stop and end tb strategy of the world health organization who. Citc is a project of the university of california, san francisco, funded by the centers for. Tb case management and contact investigation intensive november 14, 2016 curry international tuberculosis center, ucsf 300 frank h. Who treatment guidelines for multidrug and rifampicinresistant tuberculosis, 2018 update. Almost 20% of all tb strains worldwide are resistant to at least one major tb drug, including isoniazid. Management of persons exposed to multidrugresistant. Multidrug resistant tb mdr tb is multifactorial and fuelled by improper treatment of patients, poor management of supply and quality of drugs, and airborne transmission of bacteria in public.
Guidelines for the programmatic management of drug. Treatment practices, outcomes, and costs of multidrugresistant and extensively drugresistant tuberculosis, united states, 20052007. Management of persons exposed to multidrugresistant tuberculosis. The pih guide to the medical management of multidrug. The epidemiology, pathogenesis, transmission, diagnosis. Several factors should be considered in the management of persons exposed to tb i. Outcomes of bedaquiline treatment in patients with. This 2011 update of guidelines for the programmatic management of drug resistant tuberculosis is intended as a tool for use by public health professionals working in response to the sixtysecond world health assemblys resolution on prevention and control of multidrug resistant tuberculosis and extensively drug resistant tuberculosis. Pdf the emergence of multidrugresistant tuberculosis mdrtb. Management of contacts of mdr tb and xdr tb patients ecdc. A survival guide for clinicians, third edition was created through a collaboration of the curry international tuberculosis center citc and the state of california department of public health, tuberculosis control branch cdph.
Monitoring patient response to mdrtb treatment using culture. Multidrugresistant tb share this page pathophysiology. Pdf pdf icon 37k multidrug resistant tuberculosis mdr tb what is tuberculosis tb. Thus, we read with interest the article by the collaborative group for the metaanalysis of individual patient data in mdrtb treatment2017,1 the results of which support our proposal,2 from 2015, to classify antituberculosis drugs on the basis of their. The estimated global number of multidrugresistant mdr and extensively drugresistant xdrtb cases among newly diagnosed patients with pulmonary tb in the year 2012 was 450000 range 300000600000 2. The 2 reasons why multidrug resistance continues to emerge and spread are mismanagement of tb treatment and persontoperson transmission. Multidrugresistant tuberculosis mdrtb world health organization. Tuberculosis tb strains with multidrug and rifampicinresistance mdrrrtb are more difficult to treat than drugsusceptible tb and threaten global progress towards the targets of the end tb strategy set by the world health organization who. Who consolidated guidelines on drugresistant tuberculosis treatment. In several parts of the world there is an increasing incidence of mdrtb, and alarmingly, almost a third of mdrtb cases globally are. A field guide 1 introduction multidrugresistant mdr tuberculosis tb is a growing global health crisis. Clinical management of adults and children with multidrug.
Highburden multidrugresistant tb mdrtb countries by income status. Pdf on jan 1, 2015, rajendra prasad and others published multidrugresistant and extensively drugresistant tuberculosis mxdrtb. The world health organization who estimates that 5,500 cases of multidrugresistant tuberculosis mdrtb occurred among noti. The ideal number of drugs needed and treatment duration are crucial issues in the management of multidrugresistant tuberculosis mdrtb. Nathanson e, lambregtsvan weezenbeek c, rich ml, et al. Multi drug resistant tuberculosis mdr tb implications and diagnosis dr. We prepared guidance on which data to collect and what measures could improve consistency and utility for future evidencebased recommendations. Mdrtb is defined tb disease caused by strains of mycobacterium tuberculosis with in vitro resistance. The treatment of drug resistant tb has always been more difficult than the treatment of drug susceptible tb. Two nationwide drug resistance surveys have been carried out, and a third will be completed in 20. Companion handbook to the who guidelines for the programmatic management of drugresistant. Resistance to tuberculosis tb drugs is a formidable obstacle to effective tb care and prevention globally.
The purpose of this study was to establish a baseline for measuring the impact of the programmatic management of drugresistant tb program by following up on outcomes of all patients diagnosed with multidrugresistant tuberculosis in zambia between 2012 and 2014. Medical management of multidrugresistant tuberculosis 2nd edition. European centre for disease prevention and control. Antituberculosis tb drug resistance is a major public health problem that threatens progress made in tb care and control worldwide. Guidelines for clinical and operational management of drug.
Predictors of unsuccessful interim treatment outcomes of. Childhood tb is estimated at 1015% of the total burden, but little is known about the burden of mdrtb in children. Up to date, the mdrtb treatment outcome is not sufficiently understood in ethiopia. National action plan for combating multidrugresistant tuberculosis. Pdf management of patients with multidrugresistant.
Map view of the top 27 countries with the highest burden of multidrugresistant tuberculosis as designated by the world health organization in 20. However, growing evidence shows that low treatment success rate and high rates of adverse events are associated with this regimen. All projects were approved by the green light committee for access to qualityassured secondline drugs. A field guide, first edition, november 2012, a resource developed by the sentinel project on pediatric drugresistant tuberculosis. Treatment of drug resistant tb injectable drugs tbfacts. Lack of evidence in drugresistant tuberculosis clinical and operational.
The emergence of multidrugresistant tuberculosis mdrtb. Companion handbook to the who guidelines for the programmatic management of drug resistant. The contribution of the following experts and technical groups is gratefully acknowledged. Estonia, latvia, peru, the philippines, and the russian federation. Multidrugresistant tuberculosis course wma the world. Only 28% of these estimated mdrxdrtb cases are notified, and the majority of these cases are from eastern european and central. According to the world bank, lowincome economies are defined as those with an annual gross national income gni per capita of mdr tb. Multidrugresistant tuberculosis management in resourcelimited settings. Provisional cdc guidelines for the use and safety monitoring of bedaquiline fumarate. Management of multidrugresistant tuberculosis in children. Who consolidated guidelines on drug resistant tuberculosis treatment 4. We evaluate the management of mdrtb in 5 resourcelimited countries. The programmatic management of multidrugresistant tuberculosis mdrtb is entirely based on a who recommended longterm, 1824 month lasting treatment regimen.
Outcomes of multidrugresistant tuberculosis in zambia. Ecdc guidance management of contacts of mdr tb and xdr tb patients 1 executive summary the challenge multidrugresistant tuberculosis mdr tb and extensively drugresistant tuberculosis xdr tb are posing a major public health threat as well as a big challenge for tb prevention and control in the european union and european. Percentage of estimated mdrtb cases enrolled on treatment in 2011. A policy framework on decentralised and deinstitutionalised management for south africa will guide provinces in the complex process of decentralisation of drugresistant tb care and treatment. This document draws heavily from policy guidelines on the issue by the world health organization, the international union against tuberculosis and lung disease and the centers for disease control and prevention. Multidrugresistant tuberculosis management in resource. Tuberculosis tb is a disease caused by bacteria that are spread from person to person through the air.
Rao md slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Multidrugresistant tuberculosis course multidrugresistant tuberculosis mdrtb is difficult to treat and there exists a significant lack of information about this infectious disease. Experts involved in the development of the who treatment guidelines for drugresistant tb. We hope it will receive due consideration and support among. Pdf multidrugresistant and extensively drugresistant. The second edition of this handbook is based on the management of multidrugresistant tuberculosis in children. Management of contacts of mdr tb and xdr tb patients. Clofazimine for the treatment of multidrugresistant. Special article seaworth, armitige, aronson, et al.
Who treatment guidelines for multidrug and rifampicin resistant tuberculosis, 2018 update. Improving quality of patient data for treatment of. We have drawn from who international guidelines whenever possi. Current treatment of multidrug resistant tuberculosis in. Ltbi latent tb infection mdrtb multidrugresistant tuberculosis mic minimum inhibitory concentration. Globally there is a burgeoning epidemic of drug monoresistant tuberculosis tb, multidrugresistant tb mdrtb and extensively drugresistant tb xdrtb. Multidrug resistant tuberculosis treatment there are two types of such resistant tb infections. Treatment and management of multidrugresistant tb patients and their contacts sapna bamrah morris md, mba medical officer division of tuberculosis elimination centers. This field guide for the management of drug resistant tuberculosis is a practical tool intended to help health workers in the clinical and operational management of the disease.
The document includes recommendations on the treatment of multidrugresistant tb mdrtb as well as isoniazidresistant. A policy framework on decentralised and deinstitutionalised management for south africa will continue to guide provinces in the complex process of decentralisation of drug resistant tb care and treatment. This field guide for the management of drugresistant tuberculosis is a practical tool intended to help health workers in the clinical and operational management of the disease. Tuberculosis tb strains with multidrug and rifampicin resistance mdrrr tb are more difficult to treat than drugsusceptible tb and threaten global progress towards the targets of the end tb strategy set by the world health organization who. Multidrug resistant mdr tb is caused by mycobacterium tuberculosis organisms that are resistant to rifampicin and isoniazid, and the estimated number of new mdr tb cases rose from 250 000 in 2009 to 480 000 in 20. What is multidrugresistant tuberculosis mdrtb and how. Multidrugresistant mdr tb is caused by mycobacterium tuberculosis organisms that are resistant to rifampicin and isoniazid, and the estimated number of new mdrtb cases rose from 250 000 in 2009 to 480 000 in 20.
Extensively drugresistant tb xdrtb has been reported since 2007. One of the most obtruding problems for the management of patients with drugresistant tb is the lack of funding and provision of patient care. Management of drugresistant tuberculosis world health. Tb usually affects the lungs, but it can also affect other parts of the body, such as the brain, the kidneys, or the spine. Evidence of successful management of multidrugresistant tuberculosis mdrtb is mainly generated from referral hospitals in highincome countries. None of the highestburden countries are in the americas. Therefore, this study was conducted to evaluate the interim treatment outcomes of mdrtb patients in pakistan. Guidelines for clinical and operational management of drugresistant tuberculosis 20. Guidelines for the programmatic management of drugresistant. We pooled data from 5 cohorts of patients treated with bedaquiline in france, georgia, armenia, and south africa and in a multicountry.
The tbhiv and drug resistance unit of the world health organization and the writing committee gratefully. Management of patients with multidrug resistant tuberculosis article pdf available in the international journal of tuberculosis and lung disease 236. The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrugresistant, extensively drugresistant, and incurable tuberculosis previous article serial quantiferon testing and tuberculosis disease risk among young children. Management of contacts of multidrugresistant tuberculosis.
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