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TUBERCULOSIS
DRUG RESISTANCE
Temporary/permanent capacity of the organism
& their progeny to remain viable/to multiply in
the presence of the concentration of the drug
that would normally destroy/inhibit the growth
of other cells
Genesis of MDR-TB
Acquired drug
resistance
Transmission
Primary drug
resistance
Mechanism of resistance
INH
Chromosomally mediated
Loss of catalase/peroxidase
Mutation in mycolic acid synthesis
Regulators of peroxide response
Rifampin
Anti-TB Drugs
FirstLine
(H)
Isoniazid
(R) Rifampin
(Z)
Pyrazinamide
(E)
Ethambutol
Second-Line
Streptomycin
Cycloserine
Ethionamide
Amikacin
Ciprofloxacin
Prevalence of drug-resistant TB
in India
Initial MDR-TB is probably very low
MDR-TB is more common in previously treated TB
patients
Acquired resistance to Rifampicin -33-35% &
Acquired resistance to INH-50-55%
Strains resistant to Rifampicin are usually resistant to
INH whereas vice versa may not be always true
Drug-Resistant TB
Drug-resistant TB is transmitted the same way as
drug-susceptible TB
Drug resistance is divided into two types:
months of TB treatment
>2 weeks
Diagnosis of drug-resistant TB
Pre-treatment evaluation
1. Detailed history
2. Height, weight
3. CBC
4. Blood sugar
5. LFT
6. TFT
7. Urine R/E & microscopy
8. Pregnancy test
9. CXR
Childhood TB
TB in children is mainly d/t failure of TB control in adults
An infant whose mother has sputum smear positive PTB
has a high chance of becoming infected
Because of less developed immune system, children under
5 years of age are more prone to develop the disease
mostly within 2 years following infection
1-4 yrs
DOSAGE OF DRUGS
Rifampicin 10-12mg/kg
INH- 10mg/kg
Ethambutol- 20-25 mg/kg
PZA- 30-35mg/kg
Streptomycin- 15mg/kg
HIV & TB
The HIV virus damages the bodys natural defences- the
immune system-and accelerates the speed at which TB
progresses from harmless infection to life threatening condition
HIV & TB interact in several ways
Reactivation of latent infection 25-30 times more risk,
because of the stoppage of working of the immune system by
HIV
Primary infection HIV patients are at risk of being newly
infected with TB because their weakened immune system make
them more vulnerable
Prevention of DR-TB
STOP TB STRATEGY
Launched in 2006
It is to be implemented over the next 10 years as
described in the Global plan to stop TB in 2006-2015
It focuses on 5 principal indicators that are used to
measure the implementation and the impact of TB control
case detection, treatment, success, incidence,
prevalence and deaths
Targets
Treatment
regimen IP
Treatment
regimen
CP
2HRZE
4HRE
2HRZES+1HRE 5HRE
Number
of
25-39 kg
40-54 kg
55-69 kg
consumed
IP
HRZE
75/150/400
/ 275
mg/tab
2
3
4
tablets to
be
injection
CP
HRE
75/150/27
5 mg/tab
2
3
4
Gram
0.5 g
0.75 g
1g
streptomy
cin
THANK YOU