Drug Resistance in Tuberculosis and Its Public Health Management ...
Drug Resistance in Tuberculosis and Its Public Health Management ...
Drug Resistance in Tuberculosis and Its Public Health Management ...
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28<strong>Drug</strong> <strong>Resistance</strong> <strong>in</strong> <strong>Tuberculosis</strong><strong>and</strong> <strong>Its</strong> <strong>Public</strong> <strong>Health</strong> <strong>Management</strong>Dr. Paul NunnSpecific recommendations from 2011Guidel<strong>in</strong>es for Programmatic <strong>Management</strong>of <strong>Drug</strong> Resistant TB (PMDT)• Rapid drug susceptibility test<strong>in</strong>g (DST)of isoniazid <strong>and</strong> rifampic<strong>in</strong> or of rifampic<strong>in</strong> aloneis suggested over conventional test<strong>in</strong>gor no test<strong>in</strong>g at the time of diagnosis of TB• The use of sputum smear microscopy <strong>and</strong> culturerather than sputum smear microscopy aloneis recommended for the monitor<strong>in</strong>g of patientswith MDR-TB dur<strong>in</strong>g treatment• In the treatment of patients with MDR-TB:– A later generation Fluoroqu<strong>in</strong>olone should be used– Ethionamide (or prothionamide) should be usedSpecific recommendations (2)• In the treatment of patients with MDR-TB it is advised thatfour second-l<strong>in</strong>e anti-tuberculosis drugs likely to be effective(<strong>in</strong>clud<strong>in</strong>g a parenteral agent), as well as pyraz<strong>in</strong>amide,should be <strong>in</strong>cluded <strong>in</strong> the <strong>in</strong>tensive phase• Regimens should also <strong>in</strong>clude either cycloser<strong>in</strong>e or PAS(p-am<strong>in</strong>osalicylic acid) if cycloser<strong>in</strong>e cannot be used29Specific recommendations (3)• In the treatment of patients with MDR-TB,an <strong>in</strong>tensive phase of 8 months’ duration is advised• A total treatment duration of at least 20 months<strong>in</strong> patients without any previous MDR-TB treatment30The screen versions of these slides have full details of copyright <strong>and</strong> acknowledgements10