NEW WHO RECOMMENDATION FOR MULTI DRUG RESISTANT TUBERCULOSIS ,DK JHA,MD
DRUG RESISTANT TUBERCULOSIS:Resistance of tuberculosis to one drug,either Rifampicin or Isoniazid.
MULTI DRUG RESISTANT TUBERCULOSIS(MDR-TB):Resistance of tuberculosis to more than one drug commonly used for the treatment of tuberculosis.
EXENTSIVELY DRUG RESISTANT TUBERCULOSIS(XDR-TB): MDR-TB which are Resistant to fluoroquinolones and injectable drugs except streptomycine .
Currently MDR-TB is treated for a period of 18-24 months which costs approximately 2 lacs INR in India.Moreover,its diagnosis takes a time period of almost 3 months.
Now according to News release by Dr. Mario Raviglione, Director,WHO global TB control programme ,in May 2016,WHO has recommended a rapid diagnostic test and shorter treatment regimen after studying on 1200 adult MDR-TB patients over 10 countries.
The new rapid diagnostic test, called MTBDRSl is DNA based test,which detects mutation in MDR-TB strain making them resistance to fluoroquinolones and injectable drugs, thus making them XDR-TB.It takes only 24 to 48 hours.After confirming that, it is not XDR-TB,patient is put on new shorter regimen for 9-11 months.XDR-TB should not be put on this new regimen lest severe resistancr will emerge.
Drugs used for this shorter regimen are;High dose isoniazid
Ethambutal
clofizimine
prothionamide
moxifloxacin
pyrazinamide
Kanamycin(injectable)
Among these seven drugs, 5 drugs are given for a period of 4-6 months of intensive phase ,then two drugs are continued for next 5 months.
The cost as well as duration of treatment is just half of the currently used regimen.Thus compliance will be better and there will be better control of tuberculosis.