Chapter 9 : Therapy of Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis

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Multidrug-resistant tuberculosis (MDR-TB), caused by strains resistant to at least isoniazid (INH) and rifampin ( ), is difficult to treat effectively and requires medications that are expensive, toxic, and less effective than first-line anti-TB therapy. In March 2006 the original definition of extensively drug-resistant TB (XDR-TB) was reported in the CDC’s ( ). In October of the same year a revised definition was reported: XDR-TB is defined as TB resistant to INH, rifampin, a second-line injectable drug (SLID; kanamycin, amikacin, or capreomycin), and any fluoroquinolone ( ). This new definition was better able to identify a group with worse outcomes, including higher mortality rates, than with MDR-TB ( ). MDR- and XDR-TB strains are resistant to the most potent anti-TB medications that are reliably associated with successful outcomes. The outbreak of MDR-TB in New York City in the 1990s caught the world’s attention, as has the rapid spread of XDR-TB globally ( ).

Citation: Seaworth B, Griffith D. 2017. Therapy of Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis, p 129-158. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0042-2017
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Figure 1

Short-course treatment for patients diagnosed with MDR/RR-TB.

Citation: Seaworth B, Griffith D. 2017. Therapy of Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis, p 129-158. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0042-2017
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Figure 2

Building a treatment regimen for MDR-TB. Not available in U.S. SM: use only if not previously used and if documented susceptibility. Although traditionally considered a third-line drug, many experts now use LZD as a second-line drug option. Awaiting FDA approval. Reprinted and adapted from CITC publication ‘Drug-Resistant Tuberculosis-A Survival Guide for Clinicians’ ( ).

Citation: Seaworth B, Griffith D. 2017. Therapy of Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis, p 129-158. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0042-2017
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Figure 3

MDR-TB toxicity monitoring checklist.

Citation: Seaworth B, Griffith D. 2017. Therapy of Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis, p 129-158. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0042-2017
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