Full Answer
What is multidrug resistant tuberculosis?
Multidrug-Resistant TB (MDR TB) Multidrug-resistant TB (MDR TB) is caused by TB bacteria that are resistant to at least isoniazid and rifampin, the two most potent TB drugs. These drugs are used to treat all persons with TB disease. TB experts should be consulted in the treatment of MDR TB. Pre-Extensively Drug-resistant TB (pre-XDR TB) Pre ...
How is multidrug-resistant tuberculosis (MDR TB) treated?
Tuberculosis (TB) is a disease caused by bacteria that are spread from person to person through the air. TB usually affects the lungs, but it can also affect other parts of the body, such as the brain, the kidneys, or the spine. In most cases, TB is treatable and curable; however, persons with TB can die if they do not get proper treatment.
What are the resources for the management of drug resistant tuberculosis (TB)?
Recommendations. The shorter regimen consists of 4 to 6 months of moxifloxacin, amikacin, ethionamide, clofazimine, high-dose isoniazid, pyrazinamide, and ethambutol (depending on smear conversion at 4 months), followed by 5 months of moxifloxacin, clofazimine, pyrazinamide, and ethambutol.
Which drugs are used in the treatment of tuberculosis (TB)?
MDR TB is a type of TB that is resistant to at least two of the best and most important anti-TB drugs: isoniazid and rifampin. These two drugs are considered first-line drugs and are recommended for treatment of all individuals with
What is the most common treatment for non drug resistant tuberculosis?
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Multidrug-resistant tuberculosis.
| Multidrug-resistance tuberculosis | |
|---|---|
| Specialty | Infectious disease |
What is the standard practice for the treatment of non resistant pulmonary tuberculosis?
Is drug resistant TB in the United States?
What is the preferred initial treatment regimen from the CDC for tuberculosis?
What is the standard treatment for latent TB infection?
WHO TB treatment guideline 2020?
What percent of TB cases in US are MDR-TB?
How long is drug-resistant TB treated?
Is tuberculosis treatable?
What medication is prescribed for latent TB?
WHO TB treatment guidelines?
The initial phase should consist of 2 months of isoniazid, rifampicin, pyrazinamide and ethambutol. The continuation phase should consist of 4 months of isoniazid and rifampicin. Daily dosing should be used throughout treatment.
Why is isoniazid and rifampin given together?
What Is Tuberculosis (TB)?
Tuberculosis (TB)(https://www.cdc.gov/tb/publications/factsheets/general/tb.htm) is a disease caused by bacteria that are spread from person to per...
What Is Multidrug-Resistant Tuberculosis (MDR TB)?
Multidrug-resistant TB (MDR TB) is caused by an organism that is resistant to at least isoniazid and rifampin, the two most potent TB drugs. These...
What Is Extensively Drug Resistant Tuberculosis (XDR TB)?
Extensively drug resistant TB (XDR TB) is a rare type of MDR TB that is resistant to isoniazid and rifampin, plus any fluoroquinolone and at least...
How Does Drug Resistance Happen?
Resistance to anti-TB drugs can occur when these drugs are misused or mismanaged. Examples include when patients do not complete their full course...
Who Is at Risk For Getting MDR TB?
Drug resistance is more common in people who: 1. Do not take their TB medicine regularly 2. Do not take all of their TB medicine as told by their d...
How Can MDR TB Be Prevented?
The most important thing a person can do to prevent the spread of MDR TB is to take all of their medications exactly as prescribed by their health...
Is There A Vaccine to Prevent TB?
Yes, there is a vaccine for TB disease called Bacille Calmette-Guérin (BCG)(https://www.cdc.gov/tb/publications/factsheets/prevention/bcg.htm). It...
What Should I Do If I Think I Have been Exposed to Someone With TB Disease?
If you think you have been exposed to someone with TB disease, you should contact your doctor or local health department about getting a TB skin te...
What Are The Symptoms of TB Disease?
The general symptoms of TB disease include feelings of sickness or weakness, weight loss, fever, and night sweats. The symptoms of TB disease of th...
How to prevent drug resistant TB?
The most important way to prevent the spread of drug-resistant TB is to take all TB drugs exactly as prescribed by the health care provider. No doses should be missed and treatment should not be stopped early. People receiving treatment for TB disease should tell their health care provider if they are having trouble taking the drugs.
What are some examples of drug resistant TB?
Causes of Drug Resistant TB. Drug-resistant TB can occur when the drugs used to treat TB are misused or mismanaged. Examples of misuse or mismanagement include. People do not complete a full course of TB treatment. Health care providers prescribe the wrong treatment (the wrong dose or length of time)
What is XDR TB?
Extensively Drug-resistant TB (XDR TB) Extensively drug-resistant TB (XDR TB) is a rare type of MDR TB that is resistant to isoniazid and rifampin, plus any fluoroquinolone and at least one of three injectable second-line drugs (i.e., amikacin, kanamycin, or capreomycin). Because XDR TB is resistant to the most potent TB drugs, ...
Why is XDR TB so resistant to TB drugs?
Because XDR TB is resistant to the most potent TB drugs, patients are left with treatment options that are much less effective. XDR TB is of special concern for people with HIV infection or other conditions that can weaken the immune system.
What is TB in the body?
Tuberculosis (TB) is a disease caused by bacteria that are spread from person to person through the air. TB usually affects the lungs, but it can also affect other parts of the body, such as the brain, the kidneys, or the spine. In most cases, TB is treatable and curable; however, people with TB can die if they do not get proper treatment. Sometimes drug-resistant TB occurs when bacteria become resistant to the drugs used to treat TB. This means that the drug can no longer kill the TB bacteria.
What is TB resistant?
Treatment of Drug-Resistant TB. Drug-resistant TB is caused by TB bacteria that are resistant to at least one first-line anti-TB drug.
How much does it cost to treat TB?
The average cost of treating a person with TB disease increases with greater resistance. Direct costs (in 2016 U.S. dollars) average from $18,000 to treat drug-susceptible TB to $513,000 to treat the most drug-resistant form of the disease (XDR TB).When including productivity losses (e.g., lost income) experienced by patients while undergoing treatment, costs are even higher.
What is resistance to anti-TB drugs?
Resistance to anti-TB drugs can occur when these drugs are misused or mismanaged. Examples include when patients do not complete their full course of treatment; when health-care providers prescribe the wrong treatment, the wrong dose, or length of time for taking the drugs; when the supply of drugs is not always available; or when the drugs are of poor quality.
How to prevent MDR TB?
Another way to prevent getting MDR TB is to avoid exposure to known MDR TB patients in closed or crowded places such as hospitals, prisons, or homeless shelters. If you work in hospitals or health-care settings where TB patients are likely to be seen, you should consult infection control or occupational health experts.
What is MDR TB?
What is multidrug-resistant tuberculosis (MDR TB)? Multidrug-resistant TB (MDR TB) is caused by an organism that is resistant to at least isoniazid and rifampin, the two most potent TB drugs. These drugs are used to treat all persons with TB disease.
Why is XDR TB so resistant to TB drugs?
Because XDR TB is resistant to the most potent TB drugs, patients are left with treatment options that are much less effective. XDR TB is of special concern for persons with HIV infection or other conditions that can weaken the immune system.
What are the symptoms of TB in the lungs?
The symptoms of TB disease of the lungs may also include coughing, chest pain, and coughing up blood. Symptoms of TB disease in other parts of the body depend on the area affected. If you have these symptoms, you should contact your doctor or local health department.
What to do if you think you have been exposed to someone with TB?
If you think you have been exposed to someone with TB disease, you should contact your doctor or local health department about getting a TB skin test or TB blood test. And tell the doctor or nurse when you spent time with this person.
How is TB spread?
Drug-susceptible TB and drug-resistant TB are spread the same way. TB bacteria are put into the air when a person with TB disease of the lungs or throat coughs, sneezes, speaks, or sings. These bacteria can float in the air for several hours, depending on the environment. Persons who breathe in the air containing these TB bacteria can become infected.
What is monodrug resistant TB?
Monodrug-resistant TB: TB caused by organisms that show resistance to a single anti-TB drug (eg, isoniazid, rifampin, ethambutol, or pyrazinamide).
What is the treatment of DR-TB?
The treatment and management of DR-TB has evolved significantly in the past decade with the advent of rapid molecular diagnostic tests, new and repurposed drugs, results based on individual patient data meta-analysis (IPD-MA),5–12and a strategy to decentralize patient care in line with a patient-centered approach, including in high burden settings.13The WHO has recently published an evidence-based update to its MDR-TB treatment guidelines,14introducing new regimens, enhanced monitoring strategies, and a feasible implementation plan, based on an IPD-MA of data from recently completed phase III trials of delamanid and a shorter MDR-TB regimen; an IPD-MA with more than 13,100 records from patients treated with longer MDR-TB regimens in 40 countries; another IPD-MA with more than 2600 records from patients treated with the 9-month to 12-month shorter MDR-TB regimens from 15 countries; and pharmacokinetic and safety data from trials of bedaquiline and delamanid in patients less than or equal to 18 years old.14These guidelines are intended to be applicable in low-resource countries. The American Thoracic Society (ATS), the Centers for Disease Control and Prevention (CDC), the European Respiratory Society (ERS), and the Infectious Disease Society of America (IDSA) are also collaborating to develop guidelines for low-incidence, high-resource countries, which they will publish in 2019, using published IPD-MA data from more than 12,000 patients treated with MDR-TB regimens from 25 countries in 50 studies.8At the time of the writing of this article, those guidelines have not been finalized, but will be based principally on a published IPD-MA8and will be intended for settings in which mycobacterial cultures, phenotypic and molecular DST, and radiographic resources are readily available.
What is RR TB?
Rifampin-resistant TB (RR-TB): TB caused by organisms that show resistance to rifampin, but may be susceptible to isoniazid, or resistant to isoniazid (ie, MDR-TB), or resistant to other first-line TB medicines (polydrug resistant) or second-line TB medicines (eg, extensively drug-resistant TB [XDR-TB]).
What is a pre-XDR-TB?
Preextensively drug-resistant TB (pre–XDR-TB): TB caused by organisms that show multidrug resistance, and resistance to any fluoroquinolone or a second-line injectable (SLI) agent (ie, amikacin, kanamycin, or capreomycin).
What is ADSM in TB?
Patient-centered support for medication adherence (including the use of digital technologies where feasible) and active TB drug-safety monitoring and management (aDSM) are essential for anyone starting an MDR-TB regimen.
How often should posttreatment be performed?
Posttreatment monitoring should be performed at regular intervals (eg, every 6 months) for 1 to 2 years to evaluate for relapse or recurrence.
How should treatment choice and duration be determined?
Treatment choice and duration should be determined in conjunction with the strength of the drugs used for treatment, extent and severity of disease, and the treatment response as shown bacteriologically, clinically, and radiographically. Where possible, monthly cultures should be obtained during treatment. Weight should be monitored monthly.
What is XDR TB?
XDR TB is a rare type of multidrug-resistant tuberculosis. It is resistant to isoniazid and rifampin, and to second-line treatments including any one of the fluoroquinolones and at least one of three injectable drugs (amikacin, kanamycin, or capreomycin).
Is TB a disease?
Tuberculosis (TB) is a serious disease caused by bacteria that are spread from person to person through the air. TB usually affects the lungs, but it can also affect other parts of the body, such as the brain, the kidneys, or the spine. In most cases, TB is treatable and curable; however, TB can be deadly without proper treatment.
Is there a shortage of TB drugs?
Until recently, these shortages primarily involved second-line TB drugs, which are critical for treating drug-resistant cases. In a 2010 survey, 81 percent of health departments with MDR TB cases reported difficulty obtaining these second-line treatments.4 However, in recent years, isoniazid, a first line drug used in the treatment of TB disease and latent TB infection, was also in short supply.5
Is TB resistant to fluoroquinolone?
TB that is resistant to isoniazid and rifampin among first-line drugs, resistant to any fluoroquinolone and at least one second-line injectable drug. Treatment options are very limited and outcomes are often worse.
Is MDR TB curable?
TB that is resistant to at least two of the best and most important anti-TB drugs (isoniazid and rifampin). While treatment is complicated, MDR TB is often curable.
Can TB make you sick?
Not everyone infected with TB bacteria becomes sick. Most people who breathe in TB bacteria and become infected are able to fight the disease and stop the bacteria from growing. This is called latent TB infection. People with latent TB infection do not feel sick, do not have any symptoms, and cannot spread the bacteria to others.
What is the drug resistance of Mycobacterium tuberculosis?
Drug-resistant Mycobacterium tuberculosis poses substantial obstacles to tuberculosis (TB) control. In the United States, multidrug-resistant (MDR) TB (resistant to at least isoniazid and rifampin) comprises only 1.0%–1.5% of TB cases but requires lengthy regimens of toxic drugs, imposes high costs on the health care system and society, and causes high mortality rates.
What are the limitations of the TB study?
This study had some limitations. Detailed hospitalization records were unavailable for 17 patients. Moreover, documentation of care for incarcerated patients was limited. Follow-up data for all patients were unavailable after 1 year of treatment. Because outpatient care was provided by a mixture of public and private providers, we used average wholesale medication prices to estimate medication costs, which overestimated actual costs to TB clinics that have access to reduced (often one half to one third) medication prices negotiated with pharmaceutical companies. Estimates of out-of-pocket costs were not included.
How many times are you hospitalized for TB?
Most study patients were hospitalized for TB, often several times; 73% (98) were hospitalized at least 1 time and 29% were hospitalized > 2 times (range 2–6). Detailed data were available for 83% of inpatients. Among multiple possible reasons, severe worsening of TB disease was the reason for 50% of hospitalizations, followed by the need to initiate or change treatment (40%), implement respiratory isolation (21%), manage adverse events (7%), manage concurrent conditions (3%), and perform surgery (1%). One patient had undergone TB-related lung lobectomy. Four XDR TB patients were hospitalized for a median of 282 days (range 14–850) and non-XDR patients for a median of 27 days (range 1–759). Home isolation was prescribed for 37% of patients; a median of 102 days (range 4–337) for non-XDR TB patients and 257 days for the 1 XDR TB patient.
How much did TB cost in 2005?
During 2005–2007, the 373 MDR/XDR TB cases cost the US health care system an estimated $53 million ; during this time there were ≈41,000 total TB cases. Direct costs for an average XDR TB patient were 3.2 times those for an average MDR TB patient, mostly because of hospitalization costs. Only 20% of XDR TB and 28% of MDR TB patients were managed solely as outpatients. The public sector incurred 80% of the MDR TB costs and 100% of the XDR TB costs.
How long does it take to diagnose TB?
Among symptomatic patients, initial TB diagnosis was made relatively quickly, within 7 weeks of symptom onset. Nearly three-fourths (73%) of patients were hospitalized; duration was 1 month for non-XDR TB patients and 9 months for XDR TB patients. Extensive DST of first-line and second-line medications was conducted within 2 months of treatment initiation for most patients. At some point during treatment, 61% of patients were receiving a 5-drug regimen. For outpatient care, DOT was used nearly universally, including during home isolation as recommended by national guidelines ( 7 ). The physicians of most patients with MDR/XDR TB consulted with experts. However, patient management required intensive monitoring and numerous medication changes. Case management services were also intensive; a case manager was assigned to ≈90% of patients.
What is a 5 drug regimen?
We defined a 5-drug regimen ( Technical Appendix) to be consistent with US and World Health Organization recommendations ( 7, 8 ). All study definitions are in the Technical Appendix.
Is TB a Medicaid benefit?
With health care reform, a substantial proportion of uninsured TB patients are expected to become eligible for Medicaid coverage, which should increase access to health care and early TB diagnosis and decrease TB-associated hospitalizations and deaths. Prevention opportunities for MDR TB are limited. Maintaining the capacity of public health departments and of publicly financed hospitals to act as safety nets (regardless of patient insurance status) to quickly diagnose MDR/XDR TB and isolate and effectively treat the patients will be critical for preventing deaths and transmission of drug-resistant TB organisms. Investment in infection control infrastructure and the capacity to prevent TB among MDR TB patient contacts is also critical; our cost-of-illness estimates did not include these programmatic costs of preventing cases. During the 1979–1994 TB resurgence and MDR TB outbreaks in the United States, New York City renovated hospitals and the Rikers Island prison and treated 20,000 excess TB patients at a cost of ≈$1.7 billion (updated to 2010 dollars) ( 21 ).
How is M. tuberculosis identified?
M. tuberculosis was identified by molecular methods. M. tuberculosis isolates obtained at baseline and at the end of treatment or during follow-up were transferred to a central laboratory for the determination of the minimum inhibitory concentration (MIC) of bedaquiline, pretomanid, and linezolid; for MGIT drug-susceptibility testing for rifampin, isoniazid, streptomycin, ethambutol, moxifloxacin, and kanamycin; and for paired whole-genome sequencing. The laboratory manual includes full details of the microbiologic procedures.
How long does it take to treat MDR?
Five years ago, the typical duration of treatment of MDR tuberculosis ranged from 18 months to more than 2 years, with some patients receiving up to seven medications, including a second-line injectable. The incidence of side effects with these regimens is high, with 45% of patients having moderate-to-severe adverse events. 3 Patients with XDR tuberculosis had few treatment options and no standard treatment regimen. The published success rates for treatment of XDR tuberculosis were low and consistent across South Africa, averaging 14% and ranging from 2 to 22%. 4,5
How many patients with XDR have a favorable outcome?
The results were similar when stratified according to tuberculosis type. Among the 71 patients with XDR tuberculosis in the intention-to-treat population, the number classified as having a favorable outcome was 63 (89%; 95% CI, 79 to 95), and among the 38 patients with MDR tuberculosis, 35 were classified as having a favorable outcome (92%; 95% CI, 79 to 98) ( Table 2 ). The results were also consistent regardless of HIV status and linezolid dosing scheme.
What is pretomanid used for?
Pretomanid, a nitroimidazooxazine that inhibits mycolic acid biosynthesis and thereby blocks mycobacterial cell-wall production, also acts as a respiratory poison against nonreplicating bacteria after nitric oxide release under anaerobic conditions. 11,12 Pretomanid has in vitro activity against both drug-susceptible and drug-resistant (including XDR) strains of M. tuberculosis and has in vivo activity in animal models of tuberculosis. 13,14 Phase 2 studies to evaluate the early bactericidal activity of pretomanid over 14 days of daily oral monotherapy showed that the lowest dose to produce a maximal effect for early bactericidal activity was 100 mg per day. 15 Pretomanid was recently approved by the Food and Drug Administration (FDA) under the Limited Population Pathway for Antibacterial and Antifungal Drugs as part of a combination regimen with bedaquiline and linezolid for the treatment of adults with pulmonary XDR tuberculosis or with complicated MDR tuberculosis. Here, we present the results of the Nix-TB study, which evaluated the safety, side-effect profile, efficacy, and pharmacokinetics of this oral regimen.
What is bedaquiline used for?
Bedaquiline is a diarylquinoline that inhibits mycobacterial ATP synthase. 6 In a phase 2 study of bedaquiline added to a background regimen, 23 of 38 patients with XDR tuberculosis (61%) had had a response at 120 weeks after the initiation of treatment. 7 There has been increased early access to this medication, especially in South Africa. In the cohort of patients with XDR tuberculosis who started treatment between July 2014 and March 2016, bedaquiline-containing regimens were associated with a lower risk of death from any cause than were regimens that did not contain bedaquiline (hazard ratio, 0.26, 95% confidence interval [CI], 0.18 to 0.38). 8
What is linezolid used for?
Linezolid, an oxazolidinone that has been approved in many countries for the treatment of drug-resistant, gram-positive bacterial infections, inhibits bacterial protein synthesis. 9 Resistance of Mycobacterium tuberculosis to linezolid is rare, since this drug has not been widely used to treat tuberculosis.
Is Nix TB open label?
Nix-TB is an open-label, single-group study involving patients with XDR tuberculosis and patients with MDR tuberculosis that is not responsive to treatment or for which a second-line regimen had been discontinued because of side effects. All patients received 26 weeks of daily oral treatment, with an option to extend treatment to 39 weeks if they were culture-positive at week 16. An interim analysis for safety was conducted after every 15 enrollments.
What is the best treatment for TB?
The most common treatment for active TB is isoniazid INH in combination with three other drugs—rifampin, pyrazinamide and ethambutol. You may begin to feel better only a few weeks after starting to take the drugs but treating TB takes much longer than other bacterial infections.
How long does it take to treat TB?
The treatment for this type of TB takes much longer, 20 to 30 months to complete, and you may experience more side effects.
What is DOT therapy?
This means a healthcare worker will come to you to administer your medication and eliminate the concern of forgetting to take the treatment.
What are the side effects of TB?
While you are in treatment for active TB disease, you will need regular checkups to make sure your treatment is working. Everyone is different, but there are side effects associated with taking the medications, including: 1 Upset stomach, nausea and vomiting or loss of appetite 2 Tingling or numbness in the hands or feet 3 Itchy skin, rashes or bruising 4 Changes in your eyesight or blurred visions 5 Yellowish skin or eyes 6 Dark-colored urine 7 Weakness, fatigue or fever that for three or more days
What are the symptoms of TB?
Yellowish skin or eyes. Dark-colored urine. Weakness, fatigue or fever that for three or more days. It is important to tell your doctor or TB nurse immediately if you begin having any unusual symptoms while taking medicine for either preventive therapy or for active TB disease.
What to take for TB tingling?
If you are having trouble with tingling and numbness, your doctor may prescribe a vitamin B6 supplement while you are in treatment. It may also be possible to change TB medications if your side effects are serious.
Can you get TB from taking too much medicine?
You must finish your medicine and take the drugs exactly as prescribed. If you stop taking the drugs too soon you can become sick again and potentially spread the disease to others. Additionally, by taking the drugs incorrectly, TB germs that are still alive may become drug-resistant, making it harder for you to get better next time.