Publication: Multi-drug resistant tuberculosis burden and risk factors: An update
Date
2010
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
Abstract
Multi-drug resistant (MDR) tuberculosis is defined as disease caused by Mycobacterium tuberculosis with resistance to
at least two anti-tubercular drugs Isoniazid and Rifampicin. Recent surveillance data have revealed that prevalence of the
drug resistant tuberculosis has risen to the highest rate ever recorded in the history. Drug resistant tuberculosis generally
arises through the selection of mutated strains by inadequate therapy. The most powerful predictor of the presence of
MDR-TB is a history of treatment of TB. Shortage of drugs has been one of the most common reasons for the inadequacy
of the initial anti-TB regimen, especially in resource poor settings. Other major issues significantly contributing to the
higher complexity of the treatment of MDR-TB is the increased cost of treatment. Other factors also play important role
in the development of MDR-TB such as poor administrative control on purchase and distribution of the drugs with no
proper mechanism on quality control and bioavailability tests. Tuberculosis control program implemented in past has
also partially contributed to the development of drug resistance due to poor follow up and infrastructure. The association
known for centuries between TB and poverty also applies to MDR-TB, a rather significant inverse association with
MDR-TB. Various treatment strategies have been employed, including the use of standardised treatment regimens based
upon representative local susceptibility patterns, empirical treatment based upon previous treatment history and local
Drug Susceptibility Test (DST) patterns, and individualised treatment designed on the basis of individual DST results.
Treatment outcomes among MDR-TB cases have varied widely; a recent survey of five Green Line Committee (GLC)
approved sites in resource-limited countries found treatment success rates of 70%. Treatment continues to be limited in
the resource poor countries where the demand is high. The ultimate strategy to control multidrug resistant tuberculosis
is one that implements comprehensive approach incorporating treatment of multidrug-resistant tuberculosis based upon
principles closely related to those of its general DOTS strategy for TB control: sustained political commitment; a rational
case-finding strategy including accurate, timely diagnosis through quality assured culture and DST; appropriate treatment
strategies that use second-line drugs under proper case management conditions; uninterrupted supply of quality-assured
antituberculosis drugs; standardised recording and reporting system.
Key words: DOTS Plus, Multi drug resistant (MDR) tuberculosis burden, risk factors
Description
SB Marahatta
1Assistant Professor, Department of Community Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal