A15.0-3/A15.7-8/A16.0-2/A16.3-4/A16.7-9/B20.0 + (U50.00-01)
Never treat for MDR TB without laboratory confirmation, either by molecular or phenotypic (culture and sensitivity) results.
All cases should be discussed with a designated specialist centre and MDR TB medicines accessed from the designated centres.
Note: MDR TB guidelines are updated regularly. Consult the most recent National MDR TB Programme Guidelines.
DESCRIPTION
Multidrug resistant tuberculosis (MDR TB) is diagnosed when there is in vitro resistance of M. tuberculosis against, at least, rifampicin and isoniazid.
MDR TB is diagnosed exclusively on culture and sensitivity assays or rapid molecular tests. XpertMTB/RIF Ultra® only tests for rifampicin resistance and not isoniazid resistance. However, rifampicin resistance detected by XpertMTB/RIF Ultra® is sufficient to start a patient on MDR treatment pending confirmation of MDR TB by LPA.
GENERAL MEASURES
Screen all close contacts for signs and symptoms of to detect early disease.
MEDICINE TREATMENT
MDR TB prophylaxis
The effectiveness of preventive therapy in adults exposed to MDR TB bacteria is not currently known. Consult a specialist for management.
Treatment
Prolonged treatment, for 9–18 months, is required in patients diagnosed with MDR TB.
Management of MDR TB should be conducted in dedicated MDR TB clinics and hospitals with appropriate infection control measures. Patients diagnosed with MDR TB who are smear positive should be hospitalised for up to eight weeks or until they become smear negative on two consecutive tests.
Smear negative, culture positive patients should be started on MDR TB treatment in the community. MDR TB treatment should not be delayed while waiting for a bed or confirmation of MDR TB by LPA.
XDR TB and Pre-XDR TB
Patients with MDR TB who in addition have resistance to any fluoroquinolone and at least one of the 2nd line injectables (kanamycin, amikacin, or capreomycin). Pre-XDR TB is defined as MDR TB plus resistance to either a fluoroquinolone or an injectable.
Confirmation of XDR TB requires drug susceptibility testing.
Patients with XDR TB need to be referred to a TB hospital. Infection control to prevent airborne transmission is essential to prevent nosocomial transmission.
Individualised regimens based on susceptibility tests and treatment history are recommended to achieve a regimen with a minimum of 4–5 effective medicines.