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Multi-drug Resistant Tuberculosis(MDR TB)& Extensively MDR TB(XMDR TB):

Multi-drug Resistant Tuberculosis(MDR TB)& Extensively MDR TB(XMDR TB)

PowerPoint Presentation:

Prepared by: Ephrem Bekele ( MSC in CIDPH fellow at MU) Dec. 2011

Definition :

Multidrug-resistant TB (MDR TB): is TB that is resistant to at least two of the best anti-TB drugs, isoniazid and rifampicin . Extensively drug resistant TB (XDR ) :is TB which is resistant to isoniazid and rifampin , plus resistant to any fluoroquinolone and at least one of three injectable second-line drugs (i.e., amikacin , kanamycin , or capreomycin ). Definition


In 2008, an estimated 440,000 cases of MDR tuberculosis emerged globally. MDR cases reported globaly from 1994-2009 new cases 0 to 28.3% previously treated cases 0 to 61.6% Epidemology .


By 2009, a total of 58 countries had reported at least one case of XDR tuberculosis. In eight countries, reported cases of XDR tuberculosis account for more than 10% of all cases of MDR tuberculosis, The largest number of cases of XDR tuberculosis has been reported from South Africa (10.5% of all cases of MDR TB) Epidemo ……


Ethiopia, which ranks seventh on WHO's list of 22 high burden TB countries globally, is one of three countries in Africa with more than 5,000 estimated new MDR-TB infections annually. Of these, 1.6 percent of new cases and 11.8 percent of re-treatment cases are MDR-TB. Epidemo …….

Factors promoting resistance :

Resistance to anti-TB drugs can occur when these drugs are misused or mismanaged when patients do not complete their full course of treatment when health-care providers prescribe the wrong treatment Factors promoting resistance


the wrong dose, or length of time for taking the drugs when the supply of drugs is not always available when the drugs are of poor quality Failure to isolate MDR TB patients Delayed diagnosis and isolation Factors…..

Who is at risk for getting MDR TB? :

Drug resistance is more common in people who: do not take their TB medicine regularly do not take all of their TB medicine as told by their doctor or nurse HIV infection Who is at risk for getting MDR TB?

PowerPoint Presentation:

failure to respond to standard TB treatment relapse following standard TB treatment come from areas of the world where drug-resistant TB is common have spent time with someone known to have drug-resistant TB disease

Mechanism of Resistance:

TB specific drugs INH, PZA, ETH Antibiotics with activity against TB RIF Aminogycosides Flouroquinolones Mechanism of Resistance

Mechanism of res…..:

INH Chromosomally mediated Loss of catalase / peroxidase Mutation in mycolic acid synthesis Regulators of peroxide response Mechanism of res…..

Mechanism of res……:

Rifampin Reduced binding to RNA polymerase Clusters of mutations at “ Rifampin Resistance Determining Region” (RRDR) Reduced Cell wall permeability Mechanism of res……

Treatment :

Can be cured with long term treatment of second-line drugs It has a mortality rate of up to 80%, which depends on a number of factors, How many drugs the organism is resistant to (the fewer the better) How many drugs the patient is given (patients treated with five or more drugs do better) Whether an injectable drug is given or not (it should be given for the first three months at least) Treatment


The expertise and experience of the physician responsible How co-operative the patient is with treatment Whether the patient is HIV positive or not In general, treatment courses are measured in months to years; MDR-TB may require surgery, and death rates remain high despite optimal treatment. Treatm …….

PowerPoint Presentation:

The treatment of MDR-TB must be undertaken by a physician experienced in the treatment of MDR-TB. . Treatment of MDR-TB must be done on the basis of sensitivity testing: It is impossible to treat such patients without this information suspected MDR-TB, the patient should be started on SHREZ + MXF + cycloserine pending the result of laboratory sensitivity testing. A gene probe for rpoB is available in some countries, which serves as a useful marker for MDR-TB


When sensitivities are known and resistant to both INH and RMP, five drugs should be chosen in the following order an aminoglycoside (e.g., amikacin , kanamycin ) or polypeptide antibiotic (e.g., capreomycin ) PZA EMB a fluoroquinolone : e.g., moxifloxacin , Gatifloxacin , levofloxacin , sparfloxacin ( ciprofloxacin should no longer be used [15] ); rifabutin .


Cycloserine a thioamide : prothionamide or ethionamide PAS a macrolide : e.g., clarithromycin Linezolid high-dose INH (if low-level resistance) interferon-γ Thioridazine Ampicillin .

Treatment of XMDR TB:

surgery to remove infection portions of the lung is the final option. Loboectomies pneumonectomies The center with the largest experience in this is the National Jewish Medical and Research Center Treatment of XMDR TB

Treatment of MDR TB:

Factors determining Success Culture of MDR TB Reliable susceptibility Reliable history of previous drug regimens Program to assure delivery of prescribed drugs (DOT) Correct choice of modified treatment regimen Reliable follow up Treatment of MDR TB


take all medications exactly as prescribed by their health care provider. No doses should be missed and treatment should not be stopped early Patients should tell their health care provider if they are having trouble taking the medications. If patients plan to travel, they should talk to their health care providers and make sure they have enough medicine to last while away. prevention


Health care providers can help prevent MDR TB by: quickly diagnosing cases following recommended treatment guidelines monitoring patients’ response to treatment making sure therapy is completed. Prev ……..


avoid exposure to known MDR TB patients Ask about administrative and environmental procedures for preventing exposure to TB. using personal respiratory protective devices Prev ……….

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