Multidrug-resistant tuberculosis (MDR TB)

MDR TB guidelines are updated regularly.

Consult the most recent National MDR TB Programme Guidelines.

DESCRIPTION

Isoniazid mono-resistant TB is diagnosed when there is resistance to isoniazid only.

MDR TB is diagnosed when there is resistance to rifampicin and isoniazid.

XDR TB is diagnosed when there is resistance to rifampicin and isoniazid plus resistance to fluoroquinolones and an injectable medicine e.g. kanamycin.

ISONIAZID MONO-RESISTANT TUBERCULOSIS IN ADULTS

A15.0-3/A15.7-8/A16.0-2/A16.3-4/A16.7-9/B20.0 + (U50.00-01/U50.10-11)

MEDICINE TREATMENT

Confirmed INH mono-resistant TB:

  • Rifampicin, oral, 10 mg/kg daily.

AND

  • Ethambutol, oral, 15 mg/kg daily.

AND

  • Pyrazinamide, oral, 25 mg/kg daily.

AND

  • Levofloxacin, oral, daily.
    • 30–50 kg: 750 mg
    • >50 kg: 1000 mg

LoE:III[39]

Where single medicines are not available or the pill burden is too high a FDC of RHZE dosed as per weight may be used, and levofloxacin added to this.

Treatment should be given for at least 6 months.

MULTIDRUG-RESISTANT TUBERCULOSIS (MDR TB),IN ADULTS

A15.0-3/A15.7-8/A16.0-2/A16.7-8/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

GENERAL MEASURES

Counsel and educate patients about the disease and its treatment, including treatment duration.

Screen all close contacts for signs and symptoms of MDR TB and by sputum sampling to detect early disease.

Infection control and cough etiquette is important to limit spread.

REFERRAL

  • All MDR patients.
  • All XDR patients.

MULTIDRUG-RESISTANT TUBERCULOSIS (MDR TB), IN CHILDREN

A15.0-3/A15.7-8/A16.0-2/A16.7-8/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.

GENERAL MEASURES

Suspect DR-TB when any of the features listed below is present:

  • A known source case (or contact) with drug resistant TB or high-risk source case, e.g. on TB therapy who was recently released from prison.
  • A smear positive case after 2 months of TB treatment who failed (or deteriorated on) 1stline antituberculosis treatment to which they were adherent (treatment failure or relapse within 6 months of treatment).
  • Any severely ill child with TB who failed or got worse on TB treatment.
  • Patients who defaulted TB treatment (> 2 months).
  • Treatment interruptions (< 1 month) or who relapsed while on TB treatment or at the end of treatment.
  • With recurrent TB disease after completion of TB treatment (retreatment case).

Manage confirmed DR-TB in a dedicated MDR-TB centre with appropriate infection control measures to prevent nosocomial transmission. Initiate treatment in consultation with a designated expert while awaiting referral to the designated MDR-TB centre. An uninterrupted medicine supply, direct supervision with proper education and counselling is necessary.

REFERRAL

All children.