Nonresponsive pulmonary multidrug-resistant (MDR) tuberculosis (TB)

Nonresponsive Pulmonary Multidrug-Resistant (MDR) Tuberculosis (TB)

Tuberculosis (TB) is one of the world’s deadliest illnesses and is a major public health concern. In the last two decades, multidrug-resistant (MDR) TB has emerged as a major challenge to global public health because of its resistant nature and associated death. MDR-TB is defined as TB that is resistant to at least isoniazid and rifampicin, two of the most potent first-line tuberculosis medications.

Nonresistant TB is also known as responsive TB or drug-sensitive TB. It is the form of TB that is typically treated with two drugs, isoniazid and rifampicin. Drug-sensitive TB is usually curable and can be treated in as little as 6 months. In contrast, nonresponsive TB is much more difficult to treat and requires intensive multidrug therapy for successful treatment, often taking several months to years.

Nonresponsive pulmonary MDR-TB is caused by bacteria that is resistant to two or more first-line drug treatments including isoniazid and rifampicin. This means that the TB strain is not killed or inhibited by these commonly used first-line drugs. Patients infected with nonresponsive pulmonary MDR-TB are normally treated with a combination of four or more second-line drugs ( newer, more expensive and less studied than first-line drugs) to control the infection.

Treatment of nonresponsive pulmonary MDR-TB can be difficult, costly and prolonged. It is often associated with adverse effects and drug interactions, and can be associated with a significant risk of death. Therefore, it is important to identify and treat nonresponsive pulmonary MDR-TB in its early stages before it progress to a more advanced and more difficult to treat stage.

Early diagnosis and treatment of nonresponsive pulmonary MDR-TB are critical for successful treatment. The following are some of the ways healthcare providers can diagnose and treat nonresponsive pulmonary MDR-TB:

  • Culturing specimens: Culturing specimens from respiratory secretions is a necessary part of the diagnosis of MDR-TB.
  • Performing drug susceptibility testing: A laboratory test would need to be performed in order to determine which drugs will be the most effective in treating the bacteria.
  • Providing drug therapy: Treatment of nonresponsive pulmonary MDR-TB usually involves combination therapy with four or more second-line drugs and is typically administered as an outpatient regimen guided by close monitoring.
  • Preventing spread of the infection: Infection control measures, such as isolation of cases, contact tracing and treatment of contacts, are also essential in controlling the spread of infection.