Recent advances in multi drug resistant tuberculosis &rntcp


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Recent advances in multi drug resistant tuberculosis &rntcp

  1. 1. Recent Advances in multi-drugResistant Tuberculosis &
  2. 2. Introduction Tuberculosis persists as a global publichealth problem of serious magnituderequiring urgent attention . Current global efforts to control TB havethree distinct but overlappingdimensions:humanitarion ,public health &
  3. 3. Extent of the problem In a study among 50,000 TB cases in 35countries,the WHO , centers for diseasecontrol (CDC) , and international unionagainst tuberculosis and lung diseases foundthat in india,russia,latvia,estonia,argentina. TB was resistant to the commonly prescribeddrugs isoniazid and rifampcin. One third ofthe countries surveyed had a MDR TB levelbetween
  4. 4. Extent of the problem A study conducted by the indian council ofmedical research in india centers found MDRTB training from 0.6% to 30% in respect toacqired drug resistant. High proportion ofdrug resistace have been found inwardha,new delhi,and tamilnadu. Drug resistance to isoniazid was20.9%,50.7%,23.6% respectively while MDRTB was 9.6%,33.7% and 23.3%
  5. 5. Extent of the problem Drug resistant TB has frequently beenencountered in india and its prevalence hasbeen known virtualy from the time anti TBdrugs were introduced. However, there is nostate- representated survillance data of drugresistance among patients with TB and majorlimiting factor in conducting drug resistancestudies is the lack of state level qualityassured culture and laboratory facilities
  6. 6. Causes of resistance Drug resistance TB has microbial,clinical andprogrammatic causes. from a microbiologicalperspective, the resistance is caused by agenetic mutation that makes a drug ineffecti-ve against the mutant bacilli. An inadequqte or poorly administered treat-ment regimen allows drug resistant mutantsto become the dominant strain in a patientinfected with
  7. 7. Transmission of drug –resistent TB Drug-resistent and drug-susceptible TB istransmitted in the same way. for manyyears,drug-resistent TB was believed to beless infectios than drug suceptible TB. Thisbelief was largely based on animal studies. Ithas been found that drug resistant bacilliwere not less infectios, in fact contact withpreviously untreated patients had a similarrisk of
  8. 8. Transmission of drug –resistant TB However, an increased risk of infection hasbeen found to occur when in contact with apatient with drug resistent TB who had beenpreviously treated and this increased riskresulted from prolonged exposure rather thanincreased infectiosness of the drug
  9. 9. Prevention Of MDR TB The key to the successful prevention of theemergence is adequate case finding, promptand correct diagnosis, and effective treatm-ent of infected patients. this can be achievedthrough the use of
  10. 10. DOTS PLUS DOTS Plus refers to a DOTS program thatadds components for MDR TB diagnosis,management,and treatment. The WHO-endorsed DOTS plus program began in 2000at that time,the green light committee wasestablished to promote access to high qualitysecond line drugs for appropriate use in TBcontrol
  11. 11. The DOTS plus frame work for themanagement of MDR TB.The core components are comprehensiveensuring that all essential elements of theDOTS plus strategy are included and are asfollows. Sustained political and administrative commi-tment. Diagnosis of MDR TB through qualityassured & drug suceptibility
  12. 12. The DOTS plus frame work for themanagement of MDR TB. Appropriate treatment strategies that utilizesecond line drug under proper managementconditions. Uninterrupted supply of quality-assured anti-TB
  13. 13. Treatment of MDR TB Classes of anti-TBdrugs The classes of anti-TB drugs havetraditionally been devided in to first-andsecond-line drugs withisoniazid,rifampicin,pyrazinamide,ethambutoland streptomycin being the primary
  14. 14. Drug dosages and administration Recommended dosages according to weightin DOTS PLUS Drugs <45kg >45kgKenamycin 500mg 750mgOfloxacin 600mg 800mgEthionamide 500mg 750mgEthambutol 800mg
  15. 15. Drug dosages and administration Drugs <45kg >45kgPyrazinamide 1250mg 1500mgCycloserine 500mg 750mgNa PAS 10mg
  16. 16. Management of contacts of MDR TB The followoing measures should be taken toprevent the spread of MDR TB Early diagnosis and appropriate treatment ofMDR TB cases Screening of contacts as per RNTCP andfollow-up for 2 years. Further research in to effective and non-toxicchemoprophylaxis in the areas of high MDR
  17. 17. ConclusionDOTS is a proven cost effective TB treatmentstrategy. Acombination of technical andmanagerial components, DOTS quicklymakes infectious and breaks the cycle oftransmission. Using DOTS also prevents yhedevelopment of drug- resistant strains of TBthat are often fatal and very expensive
  18. 18.