Multi-Drug Resistant Tuberculosis, MDR TB is slowly becoming a threat in our country, to the general public as well as a reason of the failure of the massive tuberculosis program that the government is aiming at.
In 2016 World health organisation came out with the updated guidelines on MDR TB. The same is being adopted by our country, for effective control of the disease. Following are its major recommendations.
Shorter MDR-TB regimen for adults & children
In patients with rifampicin-resistant or multidrug-resistant TB who have not been previously treated with second-line drugs and in whom resistance to fluoroquinolones and second-line injectable agents has been excluded or is considered highly unlikely, a shorter MDR-TB regimen of 9-12 months may be used instead of a conventional regimen (conditional recommendation, very low certainty in the evidence).
Conventional MDR-TB regimens for adults & children
2a) In patients with rifampicin-resistant or multidrug-resistant TB, a regimen with at least five effective TB medicines during the intensive phase is recommended, including pyrazinamide and four core second- line TB medicines – one chosen from group A, one from group B, and at least two from group C2 (conditional recommendation, very low certainty in the evidence). If the minimum of effective TB medicines cannot be composed as above, an agent from group D2 and other agents from D3 may be added to bring the total to five3.
2b) In patients with rifampicin-resistant or multidrug-resistant TB, it is recommended that the regimen be further strengthened with high-dose isoniazid and/or ethambutol (conditional recommendation, very low certainty in the evidence).
It is recommended that any patient – child or adult – with rifampicin-resistant TB in whom isoniazid resistance is absent or unknown be treated with a recommended MDR-TB regimen, either a shorter MDR-TB regimen, or if this cannot be used, a conventional MDR-TB regimen to which isoniazid is added.
There is no change in the recommended use of the new TB drugs from those defined by the WHO interim guidance on bedaquiline (2013) and delamanid (2014) (no recommendation for use in children). The two drugs now occupy a unique subgroup within the Add-on agents used to treat MDR-TB.
Surgical interventions in patients with MDR-TB
In patients with rifampicin-resistant or multidrug-resistant TB, elective partial lung resection (lobectomy or wedge resection) may be used alongside a recommended MDR-TB regimen (conditional recommendation, very low certainty in the evidence).