Multi-drug-resistant tuberculosis medical therapy: Difference between revisions
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(/* Medical Therapy Adapted from WHO 2013 Treatment of Tuberculosis: Guidelines – 4th ed. {{cite web| url=http://www.who.int/tb/publications/tb_treatmentguidelines/en/| title=2013 WHO Treatment of Tuberculosis: Guidelines for National Programmes (4t...) |
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*MDR-TB is defined as resistance to [[isoniazid]] and [[rifampicin]], with or without resistance to other first-line drugs. | *MDR-TB is defined as resistance to [[isoniazid]] and [[rifampicin]], with or without resistance to other first-line drugs. | ||
*Medical treatment for MDR-TB consists of '''at least 4 drugs''' that have shown effectiveness against MDR. Within these 4 drugs must be included at least one drug from each group. | *Medical treatment for MDR-TB consists of '''at least 4 drugs''' that have shown effectiveness against MDR. Within these 4 drugs must be included at least one drug from each group. | ||
*Treatment duration will depend on the culture results. The duration of therapy should be > 18 months after culture is negative. | *Treatment duration will depend on the culture results. The duration of therapy should be '''> 18 months''' after culture is negative. | ||
*Chronic cases with severe pulmonary disease may require more than 24 months of therapy. | *Chronic cases with severe pulmonary disease may require more than 24 months of therapy. | ||
*Empirical treatment should start immediately and the regimen should be modified according to the [[DST]] ([[Drug susceptibility testing]]) results. | *Empirical treatment should start immediately and the regimen should be modified according to the [[DST]] ([[Drug susceptibility testing]]) results. |
Revision as of 14:20, 26 September 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]
Overview
Medical therapy for MDR-TB is based on the combination at least 4 drugs, one drug from each of the drug groups for TB. The duration of the treatment should be at least 18 months, depending on the culture results and clinical improvement.
Medical Therapy Adapted from WHO 2013 Treatment of Tuberculosis: Guidelines – 4th ed. [1]
- MDR-TB is defined as resistance to isoniazid and rifampicin, with or without resistance to other first-line drugs.
- Medical treatment for MDR-TB consists of at least 4 drugs that have shown effectiveness against MDR. Within these 4 drugs must be included at least one drug from each group.
- Treatment duration will depend on the culture results. The duration of therapy should be > 18 months after culture is negative.
- Chronic cases with severe pulmonary disease may require more than 24 months of therapy.
- Empirical treatment should start immediately and the regimen should be modified according to the DST (Drug susceptibility testing) results.
- Drugs in each group must be used, in order of preference, as shown below.[2]
- The following treatment regimens show daily dosing for each drug.
▸ Click on the following categories to expand treatment regimens.
MDR Tuberculosis ▸ Adults ▸ Children |
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Drugs Used in Drug-Resistant Tuberculosis
Groups | Drugs |
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Group 1: First-line oral drugs |
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Group 2: Injectable drugs |
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Group 3: Fluoroquinolones | |
Group 4: Oral bacteriostatic second-line drugs |
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Group 5: Agents with unclear role in treatment of drug resistant-TB |
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Adapted from WHO 2013 Treatment of Tuberculosis: Guidelines – 4th ed.[1] |
Bedaquiline
- Bedaquiline is an oral diarylquinoline recently approved by the FDA (Dec 2012) for the treatment of MDR TB when other alternatives are not available.[4]
- This drug should be used with clinical expert consultation as part of combination therapy (minimum four-drug treatment regimen) and administered by direct observation to adults aged ≥18 years with a diagnosis of pulmonary MDR TB.[4]
- Dosage: 400 mg daily PO for 2 weeks, followed by 200 mg three times a week for 22 weeks.[4]
References
- ↑ 1.0 1.1 1.2 1.3 "2013 WHO Treatment of Tuberculosis: Guidelines for National Programmes (4th Edition)".
- ↑ Caminero, José A; Sotgiu, Giovanni; Zumla, Alimuddin; Migliori, Giovanni Battista (2010). "Best drug treatment for multidrug-resistant and extensively drug-resistant tuberculosis". The Lancet Infectious Diseases. 10 (9): 621–629. doi:10.1016/S1473-3099(10)70139-0. ISSN 1473-3099.
- ↑ "WHO Guidance for national tuberculosis programmes on the management of tuberculosis in children, 2014" (PDF).
- ↑ 4.0 4.1 4.2 "Provisional CDC Guidelines for the Use and Safety Monitoring of Bedaquiline Fumarate (Sirturo) for the Treatment of Multidrug-Resistant Tuberculosis 2013".