Fact sheets drugresistant tb multidrugresistant tuberculosis. Multidrugresistant tuberculosis mdr tb in hiv endemic settings is a major threat to public health. Treatment success rates of multidrugresistant tuberculosis mdr tb is a key issue that cannot be ignored. Improving detection of multidrugresistant tuberculosis in. Recent reports of the outcomes of treatment for mdrtb describe better outcomes in. This guide can be found in electronic format at resources. Extensively drugresistant tuberculosis xdr tb appeared following the misuse of secondline drugs. We hope it will receive due consideration and support among.
Whenever possible, management of children with mdr tb should take place within the activities of a national tb program ntp. Management of these adverse reactions symptomatically withwithout modification of the mdr tb regimen was noted if documented in the case file treatment card. The incidence of drugresistant tb has increased since the introduction of streptomycin, the first antituberculosis drug. European centre for disease prevention and control. Monitoring patient response to mdrtb treatment using culture. Any person who shared the air space with an mdr tb patient for a relatively prolonged time e. The term active tb drugsafety monitoring and management abbreviated as adsm describes a new tb programme component to provide for the active and systematic clinical and laboratory assessment of patients on treatment for xdr tb, or with new tb drugs or novel mdr tb regimens to detect, manage and report suspected or confirmed drug toxicities. Management of persons exposed to multidrugresistant. If activities occur outside of an ntp, all efforts should be made. A programme manual can be the vehicle for disseminating operational and.
Tuberculosis tb continues to impose a significant clinical and socioeconomic burden globally. This file should be updated regularly at least once. Mdr tb multidrugresistant tuberculosis ntp national tuberculosis programme tb tuberculosis. Contact investigation should be integrated into routine programmatic management of mdr tb. Identify strategies for managing side effects to secondline medications 4. South africa guidelines for the management of drug resistant tb the standardised regimen consists of at least six months intensive phase treatment with five drugs. Treatment outcomes for multidrugresistant tuberculosis. Treatment strategies for mdrtb and xdrtb companion.
Ineffective tb management of this type often results from a scarcity of adequately trained. Also included is an overview of organisational issues that can have an important impact on tb control programmes. Guidelines for management of tb, drtb and leprosy in ethiopia sixth edition november 2017 addis ababa page i national guidelines for tb, drtb and leprosy in ethiopia foreword tuberculosis tb is a major public health problem throughout the world by infecting an estimated onethird of the worlds population and putting them at risk of developing. Treatment of drugresistant tuberculosis american journal of respiratory and critical care medicine, 2019.
Use of drugsusceptibility testing for management of drug. Mdr tb case management learning objectives upon completion of this session, participants will be able to. While there has been significant progress in the diagnosis and management of the infection in recent decades, many challenges remain. Drtb is a laboratory diagnosis and therefore qualityassured laboratory services are of paramount importance. Management of such patients should be undertaken by individuals with expertise in this area or in very close consultation with such individuals, in the context of a supportive public health infrastructure.
Ethiopia is among the 30 high tb, hiv and mdr tb burden countries, with annual estimated tb incidence of 177100,000 populations and death rate of 25 per 100,000 populations for 2016. This second edition has further grown out of our familiarity in treating drugresistant tb in many different regions of the worldeastern europe, south america, north america, asia, and africawhere it is clear that. Guidelines fourth, diagnosing mdr tb cases among previously treated patients and providing effective treatment will greatly help in halting the spread of mdr tb. This field guide was created to help health workers to diagnose mdrtb, initiate secondline antitb drugs, and monitor mdrtb treatment. Multidrugresistant tuberculosis mdrtb and extensively drugresistant tuberculosis xdrtb increasingly occur in resourceconstrained settings. Although the incidence of tuberculosis tb in uganda is declining, multidrug resistant tb mdr tb, a strain of tb that cannot be treated with the two most powerful firstline medicines, is a growing concern. This training material is based on the who documents including the companion. Who to consider for an expanded empiric mdr tb regimen patients in whom tb treatment is failing i. Before starting a patient on treatment for multidrug resistant ltbi mdr ltbi, ensure active tb. Mdr tb case management ann raftery, rn, bsn, phn, msc curry international tuberculosis center tb case management and contact investigation intensive march 1922, 2019 document and address side effects minor side effects are common in first few months of treatment poor or delayed management of side effects can result in nonadherence to treatment. Mdr tb is a substantial and underreported problem in subsaharan africa ssa, with recognised cases projected to increase with advancement in diagnostic technology. Management of contacts of mdrtb patients companion. We have drawn from who international guidelines whenever possi.
This field guide was created to help health workers to diagnose mdr tb, initiate secondline anti tb drugs, and monitor mdr tb treatment. Identification particulars tick or describe the answer in the spaces provided and leave boxes on the right for codingofficial use only. This is especially true in ugandas lira district, a commercial hub in the northern region. As the management of contacts of mdr tb and xdr tb.
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 dr tb. This book is a companion handbook to existing who policy guidance on the management of multidrugresistant tuberculosis, including the who guidelines for the programmatic management of drugresistant tuberculosis, who interim policy guidance on the use of bedaquiline in the treatment of multidrugresistant tuberculosis, and the who interim policy guidance on the use of delamanid in the. Pdf tuberculosis tb remains one of the deadliest infectious diseases responsible for millions of deaths annually across the world. Legal issues around the management of drugresistant tuberculosis dr tb are complex and have been addressed in separate documents, guided by evolving health legislation and the constitution of. Mdrtb multidrugresistant tuberculosis mic minimum inhibitory concentration mods microscopic observation of drug susceptibility mott mycobacteria other than tuberculosis msh management sciences for health m xdrtb multi or extensively drugresistant tb ncb ngo coordinating body ngo nongovernmental organization npv national pharmacovigilance centre.
Chapter 9 treatment of drugresistant tuberculosis in special conditions and. Management of contacts of multidrugresistant tuberculosis. Annex 4 list of complementary documents available on the. Multidrugresistant tuberculosis mdr tb and extensively drugresistant tuberculosis xdr tb increasingly occur in resourceconstrained settings. Medical management of multidrugresistant tuberculosis. A policy framework on decentralised and deinstitutionalised management for south africa will continue to guide provinces in the complex process of decentralisation of drugresistant tb care and treatment. The world health organization standards for tuberculosis. Guidelines for the management of multidrugresistant. Action taken now, while it is still possible to reverse the development and transmission of mdr tb. There is a paucity of evidence that assessed studies on the treatment of mdr tb, which focus on the effectiveness of the directly. The document includes recommendations on the treatment of multidrugresistant tb mdr tb as well as isoniazidresistant. Management of drugresistant tb can be difficult and may necessitate use of secondline drugs andor surgical resection. Identify resources for education, training, and expert consultation.
More recently the emergence of extensively drugresistant tb xdr tb has added to the complexity of tb care and treatment. The difficulty of active case finding among mdr tb contacts should not be underestimated. Mdrtb arises as a result of poor management of tb patients and most cases of xdrtb arise as a result of poor mdrtb management. In 2004, routine use of culture and drugsusceptibility testing dst was implemented for persons in 5 thailand provinces with a diagnosis of tuberculosis tb. Medical management of multidrugresistant tuberculosis 2nd edition. Management of contacts of mdr tb and xdr tb patients ecdc guidance 2 1 introduction 1. Drugresistant tuberculosis curry international tuberculosis center. Bedaquiline and delamanid were placed in the anti tb drug group d by the who. Two reports of treatment of mdrtb meningitis in hivnegative individuals describe the. More details on the organisation of the bmu can be found in section 5. Currently, only 10% of the estimated mdr tb cases are detected. Clinical and programmatic guide for patient management. Pdf the state of baja california, mexico, had the highest prevalence of multidrugresistant tuberculosis mdr tb in mexico in 2009.
Public health guidance by presenting the most recent scientific evidence and expert opinions on the topic, this document provides. Mdr tb numbers initiated on treatment doubled between 2010 and 20 5,3 to 10,719. The main part of the document is the summary of evidence and expert opinions. Diagnosis of pediatric mdr tb diagnostic specimens, preparation, and testing contact management recognition and initial management of a child with suspected mdr tb. Adverse drug reactions in management of multi drug. Who guideline for management of mdr tb in myanmar pdf. Copies may be obtained from the provincial tb coordinator, see annexure 4 for details. Social, economic, and psychological impacts of mdr tb. This edition also addresses the prevention of acquired mdr tb, especially among new tb patients. Treatment of drugresistant extrapulmonary tb is complicated by several issues. Guidelines for the management of multidrugresistant tuberculosis mdr tb in myanmar myanmar, may 20. Pdf social, economic, and psychological impacts of mdr. Guidelines for the programmatic management of drugresistant. Chapter 1 introduction and purpose 5 introduction of new drugs and regimens for the management of drugresistant tb in south africa.
It was prepared by path for the tuberculosis support contract ii tasc2 tb task order 02 project, ghsi02030003400. Prevention is the key to effective control of drtb. A fact sheet on multidrugresistant tuberculosis, including information on symptoms, prevention, and more. Management of multidrugresistant tuberculosis in children. Systematic approaches to the management of pediatric contacts of mdr tb patients are needed. Management of drugresistant tuberculosis world health. Antituberculosis drug resistance is a major public health problem that threatens the progress made in tuberculosis care and control worldwide. Highly immunocompromised with no evidence of ltbi or active tb disease see step. Treatment outcomes and antiretroviral uptake in multidrug. Management of contacts of mdr tb and xdr tb patients. Mdr tb patients have often experienced multiple failed courses of tb treatment, and have lost faith in the health care.1407 464 80 1276 302 938 369 384 528 8 1346 454 1434 756 704 1345 130 808 666 1275 279 462 1489 1175 340 1325 123 1441 632 437