MDR defined as
(INH & Rifampicin): (180-Park 22nd/ edition; K. Park 20th/ed p-173. K. Park21st/ed p 178-79, New RNTCP Module, www.tbcindia.org)WHO defines a multi drug resistant (MDR) strain as one that is at least resistant to isoniazid and rifampicin, with or without resistant to other anti TB drugsMultidrug Resistant TB - is defined by WHO as tuberculosis disease where the bacilli is resistant to Isonaiazid (H) and Rifampicin (R). with or without resistance to other drugs- Most common cause - Irregular consumption & frequent interruption in antitubercular treatment- In India 2-3% in new cases and 14%-17% in re-treatment cases - Estimated 99,000 cases every year- Prevention of MDR-TB is given priority under RNTCP rather than its treatmentManagement of MDR-TB is preferably undertaken at DOTS Plus site with experience, expertise and availability of required diagnostic and treatment facilities.Criteria for Identification of MDR-TB suspects:- A new smear positive patient remaining smear positive at the end of fifth month- A new smear negative patient becoming smear positive at the end of fifth month- A patient treated with regimen for previously treated remaining positive at fourth month- Smear positive contacts of an established / confirmed MDR-TB caseDiagnosis - Culture & drug susceptibility testing from a quality- assured laboratoryMDR - TB treatment regimen* Intensive Phase - 6-9 months, Comprises of 6 drugs (Kanamycin ), Levofloxacin (Ivx) Ethionamide , Pyrazinamide , Ethambutol and Cycloserine .* Continuation Phase - 18 months. Comprises of 4 drugs (Ivx, Eto, E and Cs) p-aminosalicylic acid (PAS) is a substitute drug if any of the bactericidal drug (Kanamycin / Ethonamide) is not tolerated.* Dosages of the drugs are based upon three weight bands * II patients receive drugs under direct observation on 6 days of the week. On the 7th day (Sunday), the oral drugs will be administered unsupervised and kanamycin will be omitted* If intolerance occurs to the drugs, ethionamide, cycloserine and PAS may be split into two dosages and the morning dose administered under DOT. The evening dose self - administered* The empty blister packs of the self -administered doses will be checked the next morning during DOT* 100 mg of pyridoxine is administered to all patients on the RNTCP MDR-TB treatment regimen.* If a patient gains at least 5 kg weight during treatment & crosses the weight- bands range, DOTS - plus site committee may consider moving the patient to higher weight-band drug dosages, whenever the patient is due for next 3-monthly supply of drugs in normal course of treatment .Follow-up schedule - Smear examination should be done monthly during IP and at least quarterly during CP.Culture examination should be done at least at 4, 6, 12, 18 and 24 months of treatmentExtensively Drug Resistant TB (XDR-TB)Q - is a subset of MDR- TB* TB bacilli, in addition to being resistant to R and H, are also resistant to fluoroquinolones and any one of the 2nd line injectable drugs (namely Kanamycin, Capreomycin, or Amikacin).* XDR-TB has been reported in India
INH only
INH & Rifampicin
More than two drugs
INH, Pyrazinamide, Ethambutol.
Communicable Diseases