ArtsAutosBooksBusinessEducationEntertainmentFamilyFashionFoodGamesGenderHealthHolidaysHomeHubPagesPersonal FinancePetsPoliticsReligionSportsTechnologyTravel

MDR-TB - a big monster

Updated on November 5, 2014

The bacteria that cause tuberculosis can develop resistance to the antimicrobial drugs that are used to treat it. So, tuberculosis that does not respond to the drugs like isoniazid and rifampicin that are used to treat it is called multi-drug resistant tuberculosis (MDR-TB).

Extensively drug-resistant TB (XDR-TB) is a form of TB caused by organisms that are resistant to isoniazid and rifampicin (i.e. MDR-TB) as well as any fluoroquinolone and any of the second–line anti-TB injectable drugs (amikacin, kanamycin or capreomycin).

These forms of TB do not respond to the standard six month treatment with first-line anti-TB drugs and can take two years or more to treat with drugs that are less potent, more toxic and much more expensive.

The following world wide statistics of MDR-TB deserve a serious attention of everyone -

  • The total number of MDR-TB cases estimated to have occurred world wide in 2004 is 424,203. In the same year, 181,408 MDR-TB cases were estimated to have occurred among previously treated TB cases alone. Three countries—China, India, and the Russian Federation—accounted for 261,362 MDR-TB cases, or 62% of the estimated global burden.
  • In 2010, the World Health Organization (WHO) estimated that there were globally 290,000 cases of MDR-TB among those cases of pulmonary TB that were reported to them. It was also estimated that in total there were 650,000 cases of MDR-TB among the world’s 12 million prevalent cases of TB.
  • There are 27 "high burden" countries for MDR-TB. These are countries where there are at least 4,000 cases of MDR TB each year, and/or at least 10% of newly registered TB cases are of MDR TB. The high burden countries are – Armenia, Azerbaijan, Bangladesh, Belarus, Bulgaria, China, DR Congo, Estonia, Ethiopia, Georgia, India, Indonesia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Myanmar, Nigeria, Pakistan, Philippines, Republic of Moldova, Russian Federation, South Africa, Tajikistan, Ukraine, Uzbekistan, and Viet Nam.
  • About 3.7% of new tuberculosis patients have multidrug-resistant strains (MDR-TB). Levels are much higher in those previously treated – about 20%. The frequency of MDR-TB varies substantially between countries. About 9% of MDR-TB cases also have resistance to two other classes of drugs, or extensively drug-resistant TB (XDR-TB). By March 2013, 84 countries had reported at least one XDR-TB case.
  • WHO estimates that there were about 0.5 million new MDR-TB cases in the world in 2011. About 60% of these cases occurred in Brazil, China, India, the Russian Federation and South Africa alone (BRICS countries).
  • 48% of patient with MDR-TB enrolled on treatment in 2009 were reported to have been successfully treated.

Cause of MDR-TB –

A strain of MDR-TB originally develops, when a case of drug-susceptible tuberculosis is improperly or incompletely treated. This occurs –

  • When a physician does not prescribe proper treatment regimens or
  • When a patient is unable to adhere to therapy.

Improper treatment allows individual TB bacilli that have natural resistance to a drug to multiply. Eventually, the majority of bacilli in the body are resistant. Once a strain of MDR-TB develops, it can be transmitted to others just like a normal drug-susceptible strain.

Factors contributing to its development –

The following factors contribute to the development of MDR-TB -

  • Noncompliance or inadequate compliance with anti-tuberculosis drug therapy
  • Delayed diagnosis and delayed determination of drug susceptibility, which may take several weeks
  • Susceptibility of immune-suppressed individuals for rapid disease progression, which may result in rapid transmission of the disease to other immune-suppressed patients
  • Inadequate isolation arrangements and other environmental safety conditions, especially in confined areas like prisons

The success of treatment depends upon how quickly a case of TB is identified as drug resistant and whether an effective drug therapy is available. The second-line drugs used in cases of MDR-TB are often less effective and more likely to cause side effects.

DOTS Program –

DOTS stands for Directly Observed Treatment Sort Course. It is a strategy used to reduce the number of tuberculosis cases. In DOTS, the health workers observe patients as they take their medicine because many patients fail to take their medication when left alone. This contributes to the spread of MDR-TB. DOTS remains at the heart of the Stop TB Strategy.

A DOTS program should incorporate the following five elements as per recommendations of WHO -

  • Political commitment with sufficient financing – It includes legislation, planning, human resources, management, and training.
  • Case detection through strengthened laboratory network – It requires strengthening TB laboratories, and drug resistance surveillance.
  • Standard treatment under supervision and with patient support – It includes TB treatment and program management guidelines, International Standards of TB Care (ISTC), Practical Approach to Lung Health (PAL), and community-patient involvement.
  • An effective drug supply and management system – It includes availability of TB drugs, TB drug management, global drug facility (GDF), and green light committee (GLC).
  • Monitoring and evaluation system and impact assessment – It includes TB recording and reporting systems, global TB control report, data and country profiles, TB planning and budgeting tool, WHO epidemiology and surveillance online training.

MDR-TB is a major public health problem that threatens progress made in TB care and control worldwide. Drug resistance arises due to improper use of antibiotics in chemotherapy of drug-susceptible TB patients. This improper use is a result of a number of actions including administration of improper treatment regimens and failure to ensure that patients complete the whole course of treatment. Essentially, drug resistance arises in areas with weak TB control programs. A patient, who develops active MDR-TB strain, can transmit this form of TB to other individuals. The frightening monster of MDR-TB is to be stopped in its tracts before it becomes unmanageable.





Comments

    0 of 8192 characters used
    Post Comment

    • Dr Pran Rangan profile imageAUTHOR

      Dr Pran Rangan 

      4 years ago from Kanpur (UP), India

      Thanks. Ordinary TB is not a big problem but MDR-TB and XDR-TB are emerging as big threat to the public health.

    • Dana Tate profile image

      Dana Tate 

      4 years ago from LOS ANGELES

      The good thing I people are no longer dying from this disease.

    working

    This website uses cookies

    As a user in the EEA, your approval is needed on a few things. To provide a better website experience, hubpages.com uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

    For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at: https://hubpages.com/privacy-policy#gdpr

    Show Details
    Necessary
    HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
    LoginThis is necessary to sign in to the HubPages Service.
    Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
    AkismetThis is used to detect comment spam. (Privacy Policy)
    HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
    HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
    Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
    CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
    Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the googleapis.com or gstatic.com domains, for performance and efficiency reasons. (Privacy Policy)
    Features
    Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
    Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
    Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
    Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
    Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
    VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
    PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
    Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
    MavenThis supports the Maven widget and search functionality. (Privacy Policy)
    Marketing
    Google AdSenseThis is an ad network. (Privacy Policy)
    Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
    Index ExchangeThis is an ad network. (Privacy Policy)
    SovrnThis is an ad network. (Privacy Policy)
    Facebook AdsThis is an ad network. (Privacy Policy)
    Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
    AppNexusThis is an ad network. (Privacy Policy)
    OpenxThis is an ad network. (Privacy Policy)
    Rubicon ProjectThis is an ad network. (Privacy Policy)
    TripleLiftThis is an ad network. (Privacy Policy)
    Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
    Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
    Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
    Statistics
    Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
    ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
    Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)