Nonresponsive pulmonary multidrug-resistant (MDR) tuberculosis (TB)
Nonresponsive Pulmonary Multidrug-Resistant (MDR) TB
Pulmonary Multidrug-Resistant TB (MDR-TB) is a serious and difficult-to-treat form of the disease. Patients with MDR-TB, who cannot respond to the standard drug therapy, need special, and more expensive, treatments and longer-term care. MDR-TB is a major public health problem in many countries as it is associated with considerable mortality and morbidity.
Patients with nonresponsive pulmonary MDR-TB need to follow a longer-term treatment and care regimen, usually requiring 6 to 24 months or more, depending on the severity of their illness. Treatment and care needs to focus on killing the TB bacteria, restoring function, addressing long-term sequelae, psychosocial support, and preventing transmission. The long-term nature of MDR-TB requires a specific approach from health authorities, funders, and providers.
Risk Factors
Risk factors for MDR-TB may include:
- HIV infection
- Inadequate treatment of a previous episode of TB
- Exposure to previously untreated or inadequately treated cases of MDR-TB
- Immunity suppression or malnourishment
- Immigration
- Living in overcrowded or underserved areas
Diagnosis
MDR-TB can be diagnosed with sputum smear microscopy, culture and drug susceptibility testing (DST). In many settings, diagnosis of MDR-TB can be established quickly and accurately, however, in low-resource settings the diagnosis process may be slow and the results inaccurate.
Treatment and Care
The treatment of MDR-TB requires an intensive phase of 6 to 8 months of administration of combinations of drugs under direct observation. Patients must adhere to their treatment and they must return for follow-up on a regular basis. This can be difficult for patients living in rural and remote areas.
Appropriate psychosocial support is necessary for patients with MDR-TB, including psychological counseling and assistance with integrating back into society. In addition, follow-up care is required to ensure the best outcomes for MDR-TB patients, including medical monitoring, social support, and counseling.
