Public health guidance by presenting the most recent scientific evidence and expert opinions on the topic, this document provides. Advice on how to implement the updated who mdr rr tb treatment guidelines will also be consolidated in the companion handbook to the who guidelines for the programmatic management of drugresistant tuberculosis, a key reference for staff implementing drugresistant tb care. To identify factors associated with loss to followup during treatment for multidrugresistant mdr tuberculosis tb in the philippines, we conducted a casecontrol study of adult patients who began receiving treatment for rifampinresistant tb during july 1december 31, 2012. Guidelines fourth, diagnosing mdrtb cases among previously treated patients and providing effective treatment will greatly help in halting the spread of mdrtb. Management of contacts of mdr tb and xdr tb patients ecdc. To seek medical advice if patient has symptoms suggestive of tb such as fever, cough etc. British hiv association guidelines for the management of. A policy framework on decentralised and deinstitutionalised management for south africa was coordinated by dr.
Improving quality of patient data for treatment of multidrug. The following conditions should be referred to specialists with experience in tb management. Treatment of drugresistant extrapulmonary tb is complicated by several issues. Management of these adverse reactions symptomatically withwithout modification of the mdr tb regimen was noted if documented in the case file treatment card. Legal issues around the management of drugresistant tuberculosis dr tb are complex and have been addressed in separate documents, guided by evolving health legislation and the constitution of south africa. Current treatment of multidrug resistant tuberculosis in. When and for how long are there family members, coworkers, friends with tb or tb symptoms contact to tb mdr xdr tb what do you know about tb history of other medical conditions. Empiric treatment for mdrtb can be considered if there is clear bacteriological evidence of failure to respond to treatment, such as persistently positive sputum. Multidrugresistant tuberculosis and extensively drugresistant. Bhiva guidelines for the management of tb in adults living with hiv 2 these guidelines are dedicated to the memory of professor stephen lawn, a scientist and clinician whose pioneering work helped transform the management of tb in. It was prepared by path for the tuberculosis support contract ii tasc2 tb task order 02 project, ghsi02030003400.
The pih guide to the medical management of multidrug. This set of tools is designed to help countries develop or strengthen a multidrugresistant tuberculosis mdrtb component within their national tb strategy. Treatment of drugresistant tuberculosis american journal of respiratory and critical care medicine, 2019 full guidelines external icon. The spread of multidrugresistant mdr strains ie, strains resistant to both isoniazid and rifampicin has represented a major threat to tb control since the 1990s.
These guidelines contain recommendations based on the most recent and available. Show full abstract programmatic feasibility and costeffectiveness of treating mdr tb in lowincome and middleincome countries, in order to consider the management of mdr tb under programme. Mar 08, 2016 newer drugs for mdr tb prevention strategies. Physicians, nurse consultants, and an epidemiologist comprise the mdr tb service. A nurse case management intervention to improve mdrtbhiv co. Executive summary pdf pdf icon731 kb full guidelines pdf pdf icon 1 mb. Programmatic management of drugresistant tuberculosis. Ineffective tb management of this type often results from a scarcity of adequately trained. Counsel patient regarding the high likelihood of this side effect awareness of the cause and the probability of the symptoms abating over time may help the patient to tolerate it 1. Management of dr tb is an evolving strategy, and needs to be adapted through evidencebased information. Systematic approaches to the management of pediatric contacts of mdr tb patients are needed. Multidrugresistant tuberculosis mdr tb and extensively drugresistant tuberculosis xdr tb increasingly occur in resourceconstrained settings.
Close contacts of multidrugresistant tb mdr tb patients are defined as people living in the same household as the index patient, or spending many hours a day together with the patient in the same indoor space. Drugresistant tuberculosis curry international tuberculosis center. For mdrtb, however, the programmatic priority in most countries is on finding and. Management of drugresistant tuberculosis request pdf. There are multiple advantages to doing this, including a contextual approach, integration with other health initiatives, and health systems strengthening. This book is a companion handbook to existing who policy guidance on the management of multidrugresistant tuberculosis, including the who guidelines for the programmatic management of drugresistant tuberculosis, who. As a team, they bring a diverse set of skills, a multidisciplinary approach to the management of mdr tb and over 30 years of tb experience including. Learning objectives upon completion of this session, participants will be able to. Screening and treatment recommendations for people. For mdr tb, however, the programmatic priority in most countries is on finding and. More recently the emergence of extensively drugresistant tb xdr tb has added to the complexity of tb care and treatment.
More details on the organisation of the bmu can be found in section 5. This file should be updated regularly at least once. Procurement and supply management report for the who. Bhiva guidelines for the management of tb in adults living with hiv 2 these guidelines are dedicated to the memory of professor stephen lawn, a scientist and clinician whose pioneering work helped transform the management of tb in people living with hiv. Guidelines for the management of multidrugresistant tuberculosis mdr tb in myanmar myanmar, may 20. Figure 11 shows drug resistant tb cases since 2003 illustrating that south dakota most often has single drug resistant cases. Evaluation of the tuberculosis situation and of the interventions designed to bring it under control are discussed.
However, growing evidence shows that low treatment success rate and high rates of adverse events are associated with this regimen. Procurement and supply management report for the who european. Drugdrug interactions between mdr tb drugs and art. Guidelines for clinical and operational management of drug. Guideline treatment of tuberculosi s in adults and children version 2. Up to date, the mdrtb treatment outcome is not sufficiently understood in ethiopia. The effectiveness of surgery in the management of pulmonary tb particularly mdr tb has not, however, been documented and evaluated, its role in the tuberculosis control programme is not wellestablished and practices vary across the who european region. Cases of multidrugresistant tuberculosis mdr tb appeared after the widespread use of rifampicin from the 1970s onward. Tuberculosis tb continues to impose a significant clinical and socioeconomic burden globally.
Who who treatment guidelines for rifampicin and multidrug. European centre for disease prevention and control. Request pdf management of drugresistant tuberculosis drugresistant tuberculosis is a major public health concern in many countries. May 02, 2014 a nurse case management intervention to improve mdr tb hiv coinfection outcomes the safety and scientific validity of this study is the responsibility of the study sponsor and investigators.
All those factors result in wide variation in patient management and outcomes. Who treatment guidelines for drug resistant tuberculosis. Copies may be obtained from the provincial tb coordinator, see annexure 4 for details. At cd4 counts of less than 200 per cubic millimeter, the presentation of tuberculosis may. A policy framework on decentralised and deinstitutionalised management for south africa will continue to guide provinces in the complex process of decentralisation of drugresistant tb care and treatment. The world health organization who estimates that 480,000 new cases of multidrugresistant tuberculosis mdr tb, tuberculosis resistant to at least isoniazid and rifampicin, occurred in 2014. Mdr tb multidrugresistant tuberculosis ntp national tuberculosis programme tb tuberculosis. Adverse drug reactions in management of multi drug resistant. Management of contacts of mdr tb and xdr tb patients. A survival guide for clinicians, third edition was created. Procurement and supply management report, who european region, high mdr tb priority countries, 20 page vii unlike individual organizations and country programmes, the gdf is able to leverage the. Use of drugsusceptibility testing for management of drug. The programmatic management of multidrugresistant tuberculosis mdr tb is entirely based on a who recommended longterm, 1824 month lasting treatment regimen.
Treatment outcomes for rr tb mdr tb xdr tb patients treated with secondline drugs 6 table 4. Management of multidrugresistant tuberculosis in children. For drugsusceptible tb, contact investigation includes the treatment of active or latent tb. South africa guidelines for the management of drug resistant tb the standardised regimen consists of at least six months intensive phase treatment with five drugs. Treatment strategies for mdrtb and xdrtb companion. Whenever possible, management of children with mdr tb should take place within the activities of a national tb program ntp. Guidelines for the programmatic management of drugresistant. Tb care i is one of the main global mechanisms for implementing the united states agency for international development usaid tb strategy as well as contributing to tbhiv activities under the u. Highly immunocompromised with no evidence of ltbi or active tb disease see step.
Management of contacts of multidrugresistant tuberculosis. Frontline public health tb case management understanding of local, state and national. Muchneeded research is currently underway to more thoroughly document. Treatment outcomes for drugsusceptible tuberculosis patients treated with firstline drugs 5 table 3. This second edition has further grown out of our familiarity in treating drugresistant tb in many different regions of the worldeastern europe, south america, north america, asia, and africawhere it is clear that. Guideline treatment of tuberculosis in adults and children. Mdrtb planning toolkit introduction and users guide 3 mdrtb planning toolkit introduction and users guide. Close contacts of multidrugresistant tb mdrtb patients are defined as people living in the same household as the index patient, or spending many hours a day together with the patient in the same indoor space.
Jun 22, 2014 treatment algorithm of drug resistant tb mdr tbmdr tb start rntcp mdr tb regimen start rntcp mdr tb regimen at the end of ip the result of most recent culture positive negative extend ip for 1 month at a time, for up to 3 months max, till at least a subsequent negative followup culture result is obtained. Diagnosis of pediatric mdr tb diagnostic specimens, preparation, and testing contact management recognition and initial management of a child with suspected mdr tb. Multidrugresistant tuberculosis mdr tb is a form of tuberculosis tb infection caused by bacteria that are resistant to treatment with at least two of the most powerful firstline anti tb medications drugs, isoniazid and rifampin. Centers for disease control and prevention, european respiratory society, and infectious diseases society of america jointly sponsored this new practice guideline on the treatment of drugresistant tuberculosis dr tb. Up to date, the mdr tb treatment outcome is not sufficiently understood in ethiopia. Prevention is the key to effective control of drugresistant tb dr tb, mdr tb arises as a result of poor management of tb patients and most cases of xdr tb arise as a result of poor mdr tb management. Management of contacts of mdrtb patients companion. Management of persons exposed to multidrugresistant tuberculosis. This field guide was created to help health workers to diagnose mdr tb, initiate secondline anti tb drugs, and monitor mdr tb treatment. These challenges must be addressed and resolved in order to successfully continue programmatic expansion. This edition also addresses the prevention of acquired mdrtb, especially among new tb patients. Who consolidated guidelines on drugresistant tuberculosis treatment. Tb case management and contact investigation intensive march 2730, 2017 curry international tuberculosis center, ucsf 300 frank h. This document was informed by the protocol for outpatient treatment of mdr tb, which was developed in january.
Provided by the centers for disease control and prevention cdc. The 2015 mdr tb case was resistant to inh, rif, pza, emb, sm, rifabutin and ethionamide. Action taken now, while it is still possible to reverse the development and transmission of mdr tb. There is, therefore no point in using scarce health care resources for the treatment of drug. The incidence of drugresistant tb has increased since the introduction of streptomycin, the first antituberculosis drug. In addition, she declared that the kncv tb foundation. Use of innovative technology to improve kenya tb program management the first in africa. Pdf tuberculosis tb remains one of the deadliest infectious diseases responsible for millions of deaths annually across the world. Management of persons exposed to multidrugresistant. This book is a companion handbook to existing who policy guidance on the management of multidrugresistant tuberculosis, including the who guidelines for the programmatic management of drugresistant tuberculosis, who interim policy guidance on the use of bedaquiline in the treatment of multidrugresistant tuberculosis, and the who interim policy guidance on the use of delamanid in the. Ethiopia is among the 30 high tb, hiv and mdr tb burden countries, with annual estimated tb incidence of 177100,000 populations and death rate of 25 per 100,000 populations for 2016. Guidelines fourth, diagnosing mdr tb cases among previously treated patients and providing effective treatment will greatly help in halting the spread of mdr tb.
Before starting a patient on treatment for multidrug resistant ltbi mdr ltbi, ensure active tb. We hope it will receive due consideration and support among. Drugresistant tuberculosis dr tb threatens global tb control and is a major public health concern. The role of surgery in the treatment of pulmonary tb and. While there has been significant progress in the diagnosis and management of the infection in recent decades, many challenges remain. Management of drugresistant tuberculosis tb online.
Management of these adverse reactions symptomatically withwithout modification of the mdrtb regimen was noted if documented in the case file treatment card. Guidelines for the management of multidrugresistant. The document includes recommendations on the treatment of multidrugresistant tb mdr tb as well as isoniazidresistant. Also included is an overview of organisational issues that can have an important impact on tb control programmes. Two reports of treatment of mdrtb meningitis in hivnegative individuals describe the.
Individualised multidrugresistant tuberculosis treatment with novel. Mdr tb numbers initiated on treatment doubled between 2010 and 20 5,3 to 10,719. This edition also addresses the prevention of acquired mdr tb, especially among new tb patients. Extensively drugresistant tuberculosis xdr tb appeared following the misuse of secondline drugs. In 2004, routine use of culture and drugsusceptibility testing dst was implemented for persons in 5 thailand provinces with a diagnosis of tuberculosis tb. The document replaces other who recommendations relating to the.
Bedaquiline approved by fda in 2012 as part of combination therapy in adults with pulmonary mdr tb should be used only when an effective treatment regimen cannot otherwise be provided. Management of persons exposed to multidrugresistant tuberculosis mmwr 1992. If activities occur outside of an ntp, all efforts should be made. This training material is based on the who documents including the companion. Listing a study does not mean it has been evaluated by the u. Treatment of drugresistant tuberculosis american journal of respiratory and critical care medicine, 2019. Any person who shared the air space with an mdr tb patient for a relatively prolonged time e. In 2006, the first cases of mdr strains with further resistance to fluoroquinolone and injectable drugs were described and named extensively drugresistant tb xdr tb. Monitoring patient response to mdrtb treatment using culture.
Management of drugresistant tuberculosis the lancet. Mdr tb case management ann raftery, rn, bsn, phn, msc curry international tuberculosis center tb case management and contact investigation intensive march 1922, 2019 document and address side effects minor side effects are common in first few months of treatment poor or delayed management of side effects can result in nonadherence to treatment. Adverse drug reactions in management of multi drug. There is a shortage of highquality randomized controlled trial rct data for mdr rr tb drugs 9. Appropriate management of mdr tb cases would allow the ntp to achieve good cure rates and at the same time reduce the risk of transmission of resistant strains. The risk of active tuberculosis increases soon after infection with hiv,19 and the manifestations of pulmonary tuberculosis at this stage are similar to those in hivnegative persons. South dakota reported the first multidrug resistant tb case in 2015. Currently the national tb control programme is recording a number of confirmed mdr tb cases from selected parts of the country. Management of drugresistant tuberculosis world health.
267 422 537 333 1355 510 916 513 547 698 1417 33 299 883 142 1127 1293 771 1512 149 1577 1389 1485 1193 754 1231 1071 488 539 408 1343 1045 764 269 146 995 265 926 900 594 811 1497 631 130 1156