Tuberculosis persists as a global public health problem, with multi-drug resistant TB found in many countries including India. Studies have found MDR TB levels between 2-14% in some areas of India. The emergence of drug resistant TB can be prevented through adequate case finding, prompt diagnosis and effective treatment under DOTS programs. DOTS Plus programs were established to diagnose and treat MDR TB through quality assured drug susceptibility testing and the use of second line drugs administered properly under DOTS Plus guidelines. Contact management is also important to prevent the spread of MDR TB.

1. Recent Advances in multi-drug
Resistant Tuberculosis &RNTCP
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2. Introduction
 Tuberculosis persists as a global public
health problem of serious magnitude
requiring urgent attention .
 Current global efforts to control TB have
three distinct but overlapping
dimensions:humanitarion ,public health &
economics.
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3. Extent of the problem
 In a study among 50,000 TB cases in 35
countries,the WHO , centers for disease
control (CDC) , and international union
against tuberculosis and lung diseases found
that in india,russia,latvia,estonia,argentina.
 TB was resistant to the commonly prescribed
drugs isoniazid and rifampcin. One third of
the countries surveyed had a MDR TB level
between 2-14%.
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4. Extent of the problem
 A study conducted by the indian council of
medical research in india centers found MDR
TB training from 0.6% to 30% in respect to
acqired drug resistant. High proportion of
drug resistace have been found in
wardha,new delhi,and tamilnadu.
 Drug resistance to isoniazid was
20.9%,50.7%,23.6% respectively while MDR
TB was 9.6%,33.7% and 23.3% respectively.
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5. Extent of the problem
 Drug resistant TB has frequently been
encountered in india and its prevalence has
been known virtualy from the time anti TB
drugs were introduced. However, there is no
state- representated survillance data of drug
resistance among patients with TB and major
limiting factor in conducting drug resistance
studies is the lack of state level quality
assured culture and laboratory facilities .
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6. Causes of resistance
 Drug resistance TB has microbial,clinical and
programmatic causes. from a microbiological
perspective, the resistance is caused by a
genetic mutation that makes a drug ineffecti-
ve against the mutant bacilli.
 An inadequqte or poorly administered treat-
ment regimen allows drug resistant mutants
to become the dominant strain in a patient
infected with TB.
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7. Transmission of drug –resistent TB
 Drug-resistent and drug-susceptible TB is
transmitted in the same way. for many
years,drug-resistent TB was believed to be
less infectios than drug suceptible TB. This
belief was largely based on animal studies. It
has been found that drug resistant bacilli
were not less infectios, in fact contact with
previously untreated patients had a similar
risk of infection.
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8. Transmission of drug –resistant TB
 However, an increased risk of infection has
been found to occur when in contact with a
patient with drug resistent TB who had been
previously treated and this increased risk
resulted from prolonged exposure rather than
increased infectiosness of the drug resistant
bacilli.
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9. Prevention Of MDR TB
 The key to the successful prevention of the
emergence is adequate case finding, prompt
and correct diagnosis, and effective treatm-
ent of infected patients. this can be achieved
through the use of DOTS.
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10. DOTS PLUS
 DOTS Plus refers to a DOTS program that
adds components for MDR TB diagnosis,
management,and treatment. The WHO-
endorsed DOTS plus program began in 2000
at that time,the green light committee was
established to promote access to high quality
second line drugs for appropriate use in TB
control programes.
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11. The DOTS plus frame work for the
management of MDR TB.
The core components are comprehensive
ensuring that all essential elements of the
DOTS plus strategy are included and are as
follows.
 Sustained political and administrative commi-
tment.
 Diagnosis of MDR TB through quality
assured & drug suceptibility testing.
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12. The DOTS plus frame work for the
management of MDR TB.
 Appropriate treatment strategies that utilize
second line drug under proper management
conditions.
 Uninterrupted supply of quality-assured anti-
TB drugs.
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13. Treatment of MDR TB
 Classes of anti-TBdrugs
 The classes of anti-TB drugs have
traditionally been devided in to first-and
second-line drugs with
isoniazid,rifampicin,pyrazinamide,ethambutol
and streptomycin being the primary first-line
drugs.
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14. Drug dosages and administration
 Recommended dosages according to weight
in DOTS PLUS
 Drugs <45kg >45kg
Kenamycin 500mg 750mg
Ofloxacin 600mg 800mg
Ethionamide 500mg 750mg
Ethambutol 800mg 1000mg
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15. Drug dosages and administration
 Drugs <45kg >45kg
Pyrazinamide 1250mg 1500mg
Cycloserine 500mg 750mg
Na PAS 10mg 12mg
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16. Management of contacts of MDR TB
 The followoing measures should be taken to
prevent the spread of MDR TB
 Early diagnosis and appropriate treatment of
MDR TB cases
 Screening of contacts as per RNTCP and
follow-up for 2 years.
 Further research in to effective and non-toxic
chemoprophylaxis in the areas of high MDR .
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17. Conclusion
DOTS is a proven cost effective TB treatment
strategy. Acombination of technical and
managerial components, DOTS quickly
makes infectious and breaks the cycle of
transmission. Using DOTS also prevents yhe
development of drug- resistant strains of TB
that are often fatal and very expensive to
cure.
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