MDR TB Strategy

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MDR TB Strategy

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Data from WHO

• The data were published by WHO and CDC in March
  2006 in an article in which XDR-TB was first
  defined.
• The study, which analysed 17 690 isolates from 49
  countries, showed that
• 20 of all isolates collected were MDR-TB and
  that
• 2 were XDR-TB

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AJRCCM 2008 178 1075-1082

• Data from South Korea
• Year 2000-2002 Retrospective analysis
• 1407 pts, culture proven MDR, from University
  hosp, Natl TB hosp, KNTA
• XDR MDR
• no75 no1332
• Success 22 (29.3) 615 (46.2)
• Death at 5 yr 37 (49.3) 258 (19.4)

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Inadequate regimen (single drug)
Secondary resistance TB (acquired)
Primary resistance TB (initial)
Drug resistance in TB is man made
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MDR-TB is defined as TB resistant to the two
mainfirst-line drugs (isoniazid and rifampicin).
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XDR-TB is defined as TB resistant to multiple
drugs as well as to any one of the
fluoroquinolone drugs and to at least one of the
three injectable second-line drugs (amikacin,
capreomycin or kanamycin).
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More than 400 000 cases of multidrug- resistant
TB (MDR-TB ) emerge every year as a result of -
under investments in basic activities to control
TB, - poor management of anti-TB drugs and -
transmission of drug-resistant strains.
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MDR-TB is much more difficult and costly to treat
than drug-susceptible TB, but recent work has
shown that treatment is feasible and cost-
effective even in settings of limited resources.
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??? 1 ?????????????????????????

• Strengthen basic TB and HIV/AIDS control
  activities,
• to avoid additional emergence of MDRTB and XDR-TB
• Strengthen DOT

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??? 2 ???????????????
Scale-up the programmatic management of MDR-TB
and XDR-TB to reach the targets set forth in
the Global Plan
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??? 3 ??????????????????
Strengthen laboratory services for adequate and
timely diagnosis of MDR-TB and XDR-TB
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??? 4 ?????????
Expand surveillance of MDR-TB and XDR-TB to
better understand the magnitude and trends of
drug resistance and the links with HIV
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??? 5 ????????????????????
Foster sound infection control measures to avoid
MDR-TB and XDR-TB transmission to protect
patients, health workers, others working in
congregate settings, and the broader
community, especially in high HIV
prevalence settings
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??? 6 ???????????????
Strengthen advocacy, communication, social
mobilization (ACSM) for sustained political
commitment and a patientcentred approach to
treatment
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??? 7 ????????
Pursue resource mobilization at global, regional
and country levels to ensure that necessary
resources are available
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??? 8 ?????????????
Promote research and development into new
diagnostics, drugs, vaccines, and operational
research on MDR-TB management to shorten the
length of treatment,
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Conclusion

• Detection (the sooner the better)
• - Clinical (treatment failure at 5 months)
• - Laboratory (drug sensitivity)
• Cure all clinical cases
• - Comply to standard program management
• Monitor for success
• - Laboratory survey for primary drug resistance

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Success Factors

• Administrative Commitment
• Laboratory facility confirmation of MDR
• Medication supply- for effective regimen
• One stop service and networking
• Patient education good DOT
• - for side effect monitoring
• - avoids single drug regimen

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Success Factors

• Standardization
• Systematization