- MDR TB resists the standard 6 months treatment of TB with first line drugs.
- Requires upto two or more years of treatment with less potent but more toxic drugs.
- Very few thousand patients of MDR TB treated each year worldwide.
How to get best results from treatment of MDR?
- Patients have to be seen as partners in treatment.
- Keep them fully informed of the full course, benefits and risks of the treatment regime.
- Keep them assured that every possible attempt will be made to make their treatment as easy as possible. Also to remember that the road ahead is long and requires personal involvement.
- Side effects will be there but they will be addressed to, treated effectively, so patients will be prepared mentally for these discomforts. The effectiveness happens when breaks in treatment are avoided.
Basis of choice of drugs for treatment is made?
- Chosen on a stepwise selection through the five groups of the anti-TB drugs
- On basis of efficacy
- On basis of safety
- On basis of Cost
Basis of choice of drugs for treatment is made?
- From first group of high-dose Isoniazid, Pyrazinamide and Ethambutol none are chosen for treatment of MDR.
- From second group of Fluoroquinolones-choice is Levofloxacin.
- From third group of Injectable drugs-use the following: Capreomycin, Kanamycin, and Amikacin.
- From fourth group – the second-line medicines from which the following can be used: thioamides, cycloserine, then amino salicylic acid.
- From the fifth group the following are used: clofazimine, amoxicillin with clavulanate, linezolid, carbapenems, thioacetazone, and then clarithromycin.
- The recommended regimen is combination of minimum four drugs to which the Mycobacterium tuberculosis is likely to be susceptible.
When Bedaquiline fumarate is used?
Bedaquiline fumarate is used when effective treatment regimen cannot otherwise be provided.
Bedaquiline may be used for treating adults on a confirmed pulmonary MDR TB.
Treatment Issues in MDR cases?
- Treatment for drug-resistant TB takes up to two years
- It is very complex as well
- It is very expensive – thousands of times expensive than regular treatment
- It has many adverse toxic effects
- Many patients cannot even have access to treatment
- Nearly half of the patients die while on treatment
- Inappropriate management can have life-threatening results
- Best managed by close consultation with an expert
What are the adverse effects of MDR Treatment?
- Headache
- Burning in Hand & feet
- Numbness/ Tingling
- Diarrhea
- Orange colored urine
- Yellow colored in urine
- Rapid increase in body weight
- Gynaecomastia
- Loin pain
- Abdominal Pain
- Big toe pain
- Problem in sun light-Sunburn
- Blurred vision, color disturbances
- Joint pain
- Itching rash
- Giddiness
- Ringing in the ear /Hearing problem
- Confusion, Suicidal Tendency ,Altered behaviour
- Convulsions
- Swelling feet & swelling face
- Menstrual disturbance
