What is Multidrug Resistance Tuberculosis & its treatment? - Dr. Hirennappa B Udnur

The rise of tuberculosis is there and we are not able to eradicate the disease. Multi drug resistant tuberculosis is a resistant tuberculosis which is resistant to important drugs, isoniazid and rifampicin. The two drugs are resistant with or without resistance to others then we say MDR tuberculosis. The treatment and the duration is totally different for MDR tuberculosis. The treatment guidelines have changed and now we have 2 categories where you give intensive care treatment where you have 4 drugs continuation phase, 3 drugs pirazinamide and the duration remains the same. If it is a single isolated site of tuberculosis or if it is two or more contagious sites or if it is disseminated the duration is going to be higher in a regular non resistant tuberculosis. MDR tuberculosis is very difficult to treat because two drugs are gone. If it is a pulmonary tuberculosis we either do a sample of sputum or bronchoscopic lavage and we send it for investigations like gene expert which we can get the result within 24 hours where it is resistant to rifampicin WHO recommends to treat it as MDR tuberculosis as we assume that we still need a conventional culture for first line drug sensitivity which is going to take a time between 6 weeks to 3 months for sensitivity. It is a challenge in extrapulmonary tuberculosis and we can still do a gene expert testing and it has to be interpreted carefully with a proper clinical setting and we still need to send conventional cultures which are gold standard. You can do line probe assay for other drugs apart from rifampicin resistance to detect the MDR tuberculosis. In extreme drug resistant tuberculosis where the drug resistance is resistance to quinolones and injectable drugs used as second line drugs. The cure rate for this kind of MDR and HDR is high because the treatment is of long duration. The drugs used in MDR tuberculosis are toxic and drugs like pyrazinamide and drugs like streptomycin and aminoglycosides can cause hearing loss. So we should be careful. Most of the times the compliance is the biggest issue. That is why the duration will become 18 to 24 months. If you treat the tuberculosis properly these problems will not arise in future and for MDR we have strict guidelines by the government of India and lot of NGOs have been tied up in preventing the spread of the tuberculosis, awareness, patient motivation and reminders are given and tuberculosis is still a challenge and government of India and NGOs and private clinics have joined hands in treating this malaise.