Multi-drug-resistant tuberculosis (patient information)

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Multi-drug-resistant tuberculosis
Overview
What are the symptoms?
What are the causes?
Who is at highest risk?
Diagnosis
When to seek urgent medical care?
Treatment options
Where to find medical care for Multi-drug-resistant tuberculosis?
Prevention
What to expect (Outlook/Prognosis)?
Possible complications
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

Overview

Multidrug-resistant TB (MDR-TB) is caused by Mycobacterium tuberculosis that is resistant to at least isoniazid and rifampin, the two most potent TB drugs. Anti-tuberculosis (TB) drug resistance is a major public health problem that threatens progress made in TB care and control worldwide. Drug resistance arises due to improper use of antibiotics in chemotherapy of drug-susceptible TB patients. This improper use is a result of a number of actions including, administration of improper treatment regimens and failure to ensure that patients complete the whole course of treatment. Essentially, drug resistance arises in areas with weak TB control programmes.

What causes Multi-drug-resistant tuberculosis?

Multi-drug-resistant tuberculosis is caused by the bacterium Mycobacterium tuberculosis, which is resistant to anti-TB drugs. This resistance can occur when drugs are misused or mismanaged:

• When patients do not complete their full course of treatment
• When health-care providers prescribe the wrong treatment, 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

Who is at highest risk?

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
• Develop TB disease again, after having taken TB medicine in the past
• Come from areas of the world where drug-resistant TB is common
• Have spent time with someone known to have drug-resistant TB disease

Prevention of Multi-drug-resistant tuberculosis

To prevent multi-drug-resistant tuberculosis, the following rules should be observed:

• Take all medications exactly as prescribed by the 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

• Avoid exposure to known MDR TB patients in closed or crowded places such as hospitals, prisons, or homeless shelters:

• In the case of health care workers, who are more likely to have contact with TB patients, infection control or occupational health experts should be consulted

• Administrative and environmental procedures for preventing exposure to TB should be implemented. Once those procedures are implemented, additional measures could include using personal respiratory protective devices

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