Chapter 8 : Therapy of Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis

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This chapter deals with multidrug-resistant tuberculosis (MDR-TB), caused by strains resistant to at least isoniazid and rifampin. MDR-TB is difficult to treat and requires medications that are expensive, toxic, and less effective. MDR-and extensively drug-resistant tuberculosis (XDR-TB) strains are resistant to the most important antituberculous medications required for successful outcomes. Despite the absence of prospective clinical trials using fluoroquinolones for MDR-TB, because of considerable experience with levofloxacin and moxifl oxacin, they are regarded as critical to good treatment outcomes. Fluoroquinolone drugs should always be protected by being given in combination with several other active agents, particularly in cases of suspected or possible disease. Clofazimine is now available for MDR-TB treatment in the United States only from the manufacturer under an individual patient investigational new drug. Treatment should preferably begin with six but not fewer than four new drugs with proven susceptibility, two of which should be bactericidal. Treatment of XDR-TB is based on the same principles as is the treatment of MDR-TB. An aggressive empirical regimen is recommended prior to knowledge of drug sensitivities. Patients with MDR-TB should remain in respiratory isolation at least until they have three separate final negative sputum cultures while adherent with and responding to an optimized regimen. The current global interest offers hope that the discovery and development of new anti-TB drugs will accelerate.

Citation: Seaworth B, Longfield R. 2011. Therapy of Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis, p 120-140. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch8
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Table 1.

Treatment regimens for MDR-TB based on drug resistance and extent of disease

Citation: Seaworth B, Longfield R. 2011. Therapy of Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis, p 120-140. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch8
Generic image for table
Table 2.

Characteristics of second-line drugs for MDR-TB

Citation: Seaworth B, Longfield R. 2011. Therapy of Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis, p 120-140. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch8

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