This presentation describes how many developing nations are failing to transcribe WHO guidelines while prescribing Anti-Tb medications. A failure which is observed as MDR.
Treatment of Multidrug-resistant and Extensively Drug-Resistant Tuberculosis ...WAidid
Slideset by professor G.B. Migliori, Chair of WAidid Working group on Tuberculosis and WHO Collaborating Centre for TB and Lung Disease, Fondazione S. Maugeri, Care and Research Institute Tradate, Italy
Find more on www.waidid.com
The bacteria that cause tuberculosis (TB) can develop resistance to the antimicrobial drugs used to cure the disease. Multidrug-resistant TB (MDR-TB) is TB that does not respond to at least isoniazid and rifampicin, the 2 most powerful anti-TB drugs.
The 2 reasons why multidrug resistance continues to emerge and spread are mismanagement of TB treatment and person-to-person transmission. Most people with TB are cured by a strictly followed, 6-month drug regimen that is provided to patients with support and supervision. Inappropriate or incorrect use of antimicrobial drugs, or use of ineffective formulations of drugs (such as use of single drugs, poor quality medicines or bad storage conditions), and premature treatment interruption can cause drug resistance, which can then be transmitted, especially in crowded settings such as prisons and hospitals.
In some countries, it is becoming increasingly difficult to treat MDR-TB. Treatment options are limited and expensive, recommended medicines are not always available, and patients experience many adverse effects from the drugs. In some cases even more severe drug-resistant TB may develop. Extensively drug-resistant TB, XDR-TB, is a form of multidrug-resistant TB with additional resistance to more anti-TB drugs that therefore responds to even fewer available medicines. It has been reported in 117 countries worldwide.
Drug resistance can be detected using special laboratory tests which test the bacteria for sensitivity to the drugs or detect resistance patterns. These tests can be molecular in type (such as Xpert MTB/RIF) or else culture-based. Molecular techniques can provide results within hours and have been successfully implemented even in low resource settings.
New WHO recommendations aim to speed up detection and improve treatment outcomes for MDR-TB through use of a novel rapid diagnostic test and a shorter, cheaper treatment regimen. At less than US$ 1000 per patient, the new treatment regimen can be completed in 9–12 months. Not only is it less expensive than current regimens, but it is also expected to improve outcomes and potentially decrease deaths due to better adherence to treatment and reduced loss to follow-up.
Solutions to control drug-resistant TB are to:
cure the TB patient the first time around
provide access to diagnosis
ensure adequate infection control in facilities where patients are treated
ensure the appropriate use of recommended second-line drugs.
In 2015, an estimated 480 000 people worldwide developed MDR-TB, and an additional 100 000 people with rifampicin-resistant TB were also newly eligible for MDR-TB treatment. India, China, and the Russian Federation accounted for 45% of the 580 000 cases. It is estimated that about 9.5% of these cases were XDR-TB.
This presentation focuses on appropriate selection of antibiotics in the ICU and discusses different strategies to optimize this selection with the aim to decrease resistance and improve appropriateness.
DRUG RESISTANT TUBERCULOSIS,DIAGNOSIS AND TREATMENTDr.Lalit Kumar
VERY USEFUL PRESENTATION TO LEARN THE BASICS OF MDR/XDR-TB AS WELL AS THEIR MANAGEMENT.MOST OF THE CONTENT ARE BASED ON THE RNTCP GUIDELINES AND WHO 2013 UPDATE....
There are many ways that drug-resistant infections can be prevented: immunization, safe food preparation, handwashing, and using antibiotics as directed and only when necessary. In addition, preventing infections also prevents the spread of resistant bacteria.The main cause of antibiotic resistance is antibiotic use. When we use antibiotics, some bacteria die but resistant bacteria can survive and even multiply. The overuse of antibiotics makes resistant bacteria more common. The more we use antibiotics, the more chances bacteria have to become resistant to them.
Treatment of Multidrug-resistant and Extensively Drug-Resistant Tuberculosis ...WAidid
Slideset by professor G.B. Migliori, Chair of WAidid Working group on Tuberculosis and WHO Collaborating Centre for TB and Lung Disease, Fondazione S. Maugeri, Care and Research Institute Tradate, Italy
Find more on www.waidid.com
The bacteria that cause tuberculosis (TB) can develop resistance to the antimicrobial drugs used to cure the disease. Multidrug-resistant TB (MDR-TB) is TB that does not respond to at least isoniazid and rifampicin, the 2 most powerful anti-TB drugs.
The 2 reasons why multidrug resistance continues to emerge and spread are mismanagement of TB treatment and person-to-person transmission. Most people with TB are cured by a strictly followed, 6-month drug regimen that is provided to patients with support and supervision. Inappropriate or incorrect use of antimicrobial drugs, or use of ineffective formulations of drugs (such as use of single drugs, poor quality medicines or bad storage conditions), and premature treatment interruption can cause drug resistance, which can then be transmitted, especially in crowded settings such as prisons and hospitals.
In some countries, it is becoming increasingly difficult to treat MDR-TB. Treatment options are limited and expensive, recommended medicines are not always available, and patients experience many adverse effects from the drugs. In some cases even more severe drug-resistant TB may develop. Extensively drug-resistant TB, XDR-TB, is a form of multidrug-resistant TB with additional resistance to more anti-TB drugs that therefore responds to even fewer available medicines. It has been reported in 117 countries worldwide.
Drug resistance can be detected using special laboratory tests which test the bacteria for sensitivity to the drugs or detect resistance patterns. These tests can be molecular in type (such as Xpert MTB/RIF) or else culture-based. Molecular techniques can provide results within hours and have been successfully implemented even in low resource settings.
New WHO recommendations aim to speed up detection and improve treatment outcomes for MDR-TB through use of a novel rapid diagnostic test and a shorter, cheaper treatment regimen. At less than US$ 1000 per patient, the new treatment regimen can be completed in 9–12 months. Not only is it less expensive than current regimens, but it is also expected to improve outcomes and potentially decrease deaths due to better adherence to treatment and reduced loss to follow-up.
Solutions to control drug-resistant TB are to:
cure the TB patient the first time around
provide access to diagnosis
ensure adequate infection control in facilities where patients are treated
ensure the appropriate use of recommended second-line drugs.
In 2015, an estimated 480 000 people worldwide developed MDR-TB, and an additional 100 000 people with rifampicin-resistant TB were also newly eligible for MDR-TB treatment. India, China, and the Russian Federation accounted for 45% of the 580 000 cases. It is estimated that about 9.5% of these cases were XDR-TB.
This presentation focuses on appropriate selection of antibiotics in the ICU and discusses different strategies to optimize this selection with the aim to decrease resistance and improve appropriateness.
DRUG RESISTANT TUBERCULOSIS,DIAGNOSIS AND TREATMENTDr.Lalit Kumar
VERY USEFUL PRESENTATION TO LEARN THE BASICS OF MDR/XDR-TB AS WELL AS THEIR MANAGEMENT.MOST OF THE CONTENT ARE BASED ON THE RNTCP GUIDELINES AND WHO 2013 UPDATE....
There are many ways that drug-resistant infections can be prevented: immunization, safe food preparation, handwashing, and using antibiotics as directed and only when necessary. In addition, preventing infections also prevents the spread of resistant bacteria.The main cause of antibiotic resistance is antibiotic use. When we use antibiotics, some bacteria die but resistant bacteria can survive and even multiply. The overuse of antibiotics makes resistant bacteria more common. The more we use antibiotics, the more chances bacteria have to become resistant to them.
PLASMODIUM ( P. falciparum, P. malariae, P. ovale y P. vivax)Adriana Olivhdz
Protozoario Plasmodium es un género de protistas del filo Apicomplexa, clase Aconoidasida, orden Haemosporida y familia Plasmodiidae del que se conocen más de 175 especies.1 El parásito siempre tiene dos huéspedes en su ciclo vital: un mosquito que actúa como vector y un huésped vertebrado. Al menos diez especies infectan al hombre. Para humanos hay cuatro especies de Plasmodium que provocan la malaria o paludismo: P. falciparum, P. malariae, P. ovale y P. vivax, de las cuales la primera es la más virulenta y la que produce la mayor mortalidad. Otras especies infectan a otros animales, incluyendo aves, reptiles y roedores.
RNTCP in India has gone a lot of updates in the resent times. The recent updates in RNTCP in India have been summarised in this presentation. Management of Drug sensitive and Drug Resistant TB have been included in the presentation.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Multi Drug Resistance Assay: A new Dimension for Host Directed therapy
1. Multi Drug Resistance Assay:
A New Dimension for Host
Directed Therapy
PRESENTED BY:
CYRIL JOSE
KESRIN AMRA
OP 1
2. Introduction
Availabilility of many anti-TB drugs to treat
people with tuberculosis (TB), but
resistance to these drugs is a growing
problem.
People with drug-resistant TB require
“second-line” TB drugs that, compared
with “first-line” TB drugs used to treat
drug-susceptible TB, cause more side
effects and must be taken for longer.
A rapid and accurate test could identify
people with drug-resistant TB, likely
improve patient care, and reduce the
spread of drug-resistant TB.
3. Types of resistance
Rifampicin
resistance
• TB bacteria do
not respond to
rifampicin
therapy
• Require second
line treatment
Multi drug
resistance
• Resistant to
atleast
rifampicin and
isoniazid
• Need second
line of treatment
Extensively drug
resistant
• Resistant to first
and second line
drugs
• Resistant to
fluoroquinolones
6. Selection of individualized MDR-TB
regimens
Based on the patient's history of past drug use
and on DST of isoniazid, rifampicin, the second-line
injectable agents and a fluoroquinolone. Although
resistance can develop in less than 1 month, if a
patient has used a drug for more than 1 month with
persistently positive smears or cultures, the strain
should – as a general rule – be considered as
“probably resistant” to that drug, even if DST results
indicate that it is susceptible.
Another important limitation is the turnaround time
for DST results…so the WHO recommends much
rapid and simpler Genotypic MDR assays.
7. Different levels of MDR observed are
Cross resistance
Different minimum inhibitory
concentration
Resistance to one or more drug of a
particular group
MDR assays are conducted on
Sputum specimen
Culture isolates
9. WHO recommended MDR assays
Conventional phenotypic DST
to evaluate emergence of additonal drug resistance.
to confirm resistance to other drugs.
Genotype MTBDR assay
WHO recommends SL-LPA for patients with confirmed RR-TB or MDR TB as the
initial test to detect resistance to FQs & 2nd line injectable drugs.
Among patients prescribed conventional MDR-TB, MDR assays can help to decide
who would benefit from new medicines to strengthen the regimen
WHO recommended MDR-TB regimen
Treated with different combination of 2nd line drugs.
Short term MDR-TB regimen.
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)
11. Problems associated with the DOTS strategy (observed in India)
Resistance to DOTS therapy reported
DOTS plus strategy yet to be launched to tackle the MDR-TB issue which
comprises of 2nd line drug.
DOTS strategy in India
12. Personalisation of medicines
Why do we generalise TB like most other diseases...???
Especially since MDR cases are advancing in current scenario...why do we
still follow the same treatment regimen in almost the entire population..???
Don’t you feel there is a need for MDR assays before prescribing an anti-
TB drugs..???
Why do we have to wait to ascertain the ineffectiveness of the regimen till
the patient is not responding to the treatment pattern...??
As a budding pharmacist...many of you all like me would be concerned to
protect the molecular integrity of the newly launched anti-TB drugs..!!!Due
to their haphzard prescription...!!!......Aren’t we...???
13. Challenges
Ahead...!!!!
India has 121 labs
performing XPERT
MTB/RIF.
Only 0.2% TB cases
reportedly undergoes DST
testing in these labs...!!!!
Will the newly launched
molecules bedaquilline and
Delamanid face the same
fate as streptomycin..????
14. Risks Strategy
prior treatment for tuberculosis as a risk
factor for drug resistant tuberculosis
Simultaneous MDR Genotypic assays
alongwith TB diagnosis for detecting
presence of any resistance to first line
drugs.
inadequate treatment in both the public
health system and the hospital system
because they have disease that is
resistant to isoniazid or rifampin (or
both) but are still given these first line
TB drugs as part of standard treatment)
• selection of treatment regimens on
the basis of testing for initial drug
resistance
• enhance the continuity of treatment
after patients leave the hospitals
Emergence of drug resistance by strains
due to genetic mutations allow them to
survive even in the presence of these
agents.
using several anti-TB agents
concurrently
Use of a shorter MDR-TB treatment
regimen